Fraud Manager Jobs in Remote, OR (NOW HIRING)

SR. ANALYST, NETWORK STRATEGY, PRICING & ANALYTICS
REMOTE, must be able to travel to 3031 NE STEPHENS ST. ROSEBURG, OR 97470
EMPLOYMENT TYPE: Full-Time, Exempt
About Umpqua Health
At Umpqua Health, we're more than a healthcare organization-we're a community-driven Coordinated Care Organization (CCO) dedicated to improving the health and well-being of individuals and families throughout Douglas County, Oregon. We provide integrated, whole-person care through primary care, specialty care, behavioral health services, and care coordination. Our collaborative approach ensures members receive high-quality, personalized care while supporting a stronger, healthier community.
POSITION PURPOSE
The Senior Analyst, Network Strategy, Pricing & Analytics provides advanced financial and data analysis to guide network investment decisions and ensure access to high-quality, cost-effective healthcare services. This role supports Umpqua Health's mission by developing pricing strategies, evaluating provider contracts, and leveraging value-based care models to improve health outcomes and reduce total cost of care. The position requires expertise in healthcare economics, contract valuation, predictive analytics, and strategic reporting to identify opportunities for cost savings and performance improvement.
ESSENTIAL JOB RESPONSIBILITIES

• Conduct analysis of provider performance, utilization trends, and geographic coverage to identify network gaps, inefficiencies, and opportunities for optimization.
• Develop and apply predictive models to assess contract risk, forecast financial impact, and evaluate provider behavior under varying reimbursement methodologies.
• Interpret contract rates, terms, and coding structures to assess financial implications and support contract negotiation strategies, including chargemaster considerations.
• Ensure the integrity and accuracy of integrated claims, provider, and contract data; identify and resolve data quality issues impacting reporting and analysis.
• Support compliance with applicable regulatory requirements through data monitoring, audit support, and required reporting.
• Design, develop, and maintain dashboards, reports, and data visualizations to effectively communicate insights to internal stakeholders.
• Prepare and deliver recurring provider and hospital performance reports utilizing SQL, Excel, and other reporting tools.
• Present analytical findings and strategic recommendations to leadership in a clear, concise, and professional manner.
• Apply statistical and machine learning methodologies to address complex business challenges, including fraud detection and provider performance trends.
• Collaborate with cross-functional teams to align data initiatives with organizational priorities and strategic objectives.
• Identify and support process improvements related to data collection, reporting, and analytics functions.

CHALLENGES

• Working with a variety of personalities, maintaining a consistent and fair communication style.
• Satisfying the needs of a fast-paced and challenging company.

MINIMUM QUALIFICATIONS

• Bachelor's degree in business, Finance, Mathematics, Economics, Data Science, Actuarial Science, or a related field.
• Minimum of five (5) years of experience in analytics, including financial analysis, healthcare pricing, network management, or healthcare economics.
• Advanced proficiency in Microsoft Excel and strong working knowledge of SQL.
• Experience working with complex data environments, including database management and performance analytics.
• Proficiency in at least one programming or analytics language (e.g., Python or R) and experience with data visualization tools (e.g., Tableau or Power BI).
• Working knowledge of statistical modeling and analytical methodologies.
• Strong written and verbal communication skills, including the ability to present technical information to non-technical audiences.
• Demonstrated ability to work independently and collaboratively in a cross-functional environment.

PREFERRED QUALIFICATIONS

• Master's degree in data science, Statistics, Computer Science, Health Informatics, or a related field.
• Experience in healthcare, insurance, or network management analytics.
• Advanced expertise in statistical modeling, machine learning, and experimental design.
• Extensive familiarity with healthcare data sources, including claims, provider data, and contract information.

SCHEDULE
Monday through Friday - 8:00am - 5:00pm; standard business hours with flexibility to meet service timelines.
SALARY
Wage Band 21: $100,940- $118,605
BENEFITS

• Salary is dependent on skills, experience, and education
• Generous benefits package including vacation PTO, sick leave, federal holidays, and birthday leave
• Medical, dental, and vision insurance
• 401(k) with company match (fully vested immediately)
• Company-sponsored life insurance and additional benefits
• Fitness reimbursement program
• Tuition reimbursement and more

Why Umpqua Health?
We are committed to advancing health equity by collaborating across communities, addressing systemic barriers, and ensuring fair access to care and resources. At Umpqua Health, every team member plays a vital role in making a meaningful impact, empowering healthier lives and strengthening the communities we serve.
Inclusive Culture
We foster a respectful, inclusive environment where employees feel valued, supported, and empowered.
Growth & Development
We support ongoing learning through mentorship, clear career pathways, and professional development opportunities.
Work/Life Balance
We promote flexibility and well-being so employees can thrive both professionally and personally.
Equal Opportunity
Umpqua Health is an equal opportunity employer that embraces individuals from all backgrounds. We prohibit discrimination and harassment of any kind, ensuring that all employment decisions are based on qualifications, merit, and the needs of the business. Our dedication to fairness and equality extends to all aspects of employment, including hiring, training, promotion, and compensation, without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, disability, age, veteran status, or any other protected category under federal, state, or local law.