Financial Analyst

Position: Financial Analyst

Job ID: 401576

Location: US-TX-Houston

Department: Admin - HP Finance

Talent Area: Finance

Full/Part Time: Full time

Regular/Temporary: Regular

Shift: 8a-5p

About Texas Children's Hospital

Founded in 1996, Texas Children’s Health Plan is the nation's first health maintenance organization (HMO) created just for children. We provide STAR/Medicaid and Children's Health Insurance Program (CHIP) to pregnant women, teens, children and adults in Houston and surrounding areas. Currently, the Health Plan has more than 375,000 members who receive care from our network of more than 1,100 primary care physicians, 3,200 specialists, and 70 hospitals. Texas Children's Health Plan is also the largest combined STAR/CHIP Managed Care Organization in the Harris County service area.

To join our community of 14,000+ dedicated team members, visit for career opportunities. You can also learn more about our amazing culture at

Texas Children’s is proud to be an equal opportunity employer. All applicants and employees are considered and evaluated for positions at Texas Children's without regard to mental or physical disability, race, color, religion, gender, national origin, age, genetic information, military or veteran status, sexual orientation, gender identity, marital status or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.


We are searching for a Financial Analyst — someone who works well in a fast-paced setting. In this position, you will assist the Chief Financial Officer and Finance Manager in maintaining a framework in which the Health Plan's financial and statistical performance can be continuously measured against quantifiable targets that are established by and acceptable to the various levels of authority, including Health Plan management and the Board. 

Think you’ve got what it takes? 

Job Duties & Responsibilities 

  • Maintains an audit recovery plan for TCHP’s contracts to monitor revenue and expenses that affect the bottom line. Each task is performed monthly. Compares the capitation membership against the claims data to check for any discrepancies in which TCHP is not receiving capitation dollars from their members or is paying claims for members that are not their responsibility. Checks the membership aid categories to ensure that TCHP is not carrying a member not included in their contract and provides communication to provider services. Notifies TCHP’s medical management department of non-delegated claims on members that incur high dollar claims so that they can check to see if their services were authorized correctly, and they are being well managed. Handles the recoupment of identified receivables due TCHP resulting from claims and capitation audits. Validates capitation dollars paid against the capitation file detail that is sent as backup. Monitors retroactivity on members that are added or termed on capitation.  
  • Responsible for performing various functions related to monitoring the financial performance of TCHP. Tracks, organizes, and reviews all capitation revenue and membership received for reporting purposes. Tracks, organizes, and reviews all capitation expense and membership paid for reporting purposes. Tracks, organizes, and reviews all claims paid through TCHP or paid on behalf of TCHP for reporting purposes. Maintains a database that stores TCHP’s transactions so that different data can be queried. Monitors all TCHP’s lockbox activity and researches any unusual deposits. Posts entries to the general ledger to reflect current month activity. Processes detail for each month-end close and keeps organized copies of all supporting documentation. Maintains funding reconcilements to track all funds that go through TCHP’s account. Tracks ASO revenue and Subrogation recoveries. Collects all claims and capitation voided checks and keeps a cumulative list for review. Assists in monitoring the positive pay function that is run by the bank. Works closely with the Treasury Department by sending wire transfers and monitoring the available cash in the operating account.  
  • Handles all aspects of Reinsurance so that recoupments on high dollar members are received. Collects all claim information from four sources. Which includes running reports in R&R. Processes quarterly payments to the reinsurer which includes a prior quarter true-up. Provides monthly reports that show up to date status for Commercial and Medicaid members. Provides all back-up detail on the members selected so that claims can be processed for medical expenses and eligibility and submitted when the deductible is met. Works with reinsurance broker so that any new information is shared.  
  • Responsible for formatting and translating all electronic data into usable formats sent from each TCHP’s contracts. Establishes contacts with TCHP’s eight contracts and collects all electronic data which includes capitation and claims detail. Obtains file layout formats so that correct information can be identified. Designs data masks that allow you to filter the information that needs to be used for analysis. Loads the usable data into Access databases or spreadsheets so that information on members can be analyzed. Supports the audit process in providing means to identify any discrepancies that affect TCHP’s revenue and expenses.  
  • Assists in the preparation of monthly, quarterly, and annual financial reports for internal and statutory purposes. Supports reporting requirements for TDI quarterly and annual statements. • Runs reports through Txen and Access for the IBNR lag process. Evaluates the pharmacy fund settlements TCHP has with its contracts. Supports monthly variance analysis comparing budget to actual performance by providing reports to TCHP Directors and Managers.  
  • Participates and contributes to routine projects or assignments due to certain items going on at TCHP. Assists and supports ad-hoc projects and analysis. Assists in preparing information for new bids or proposals for new business. Assists in the actuarial development of rates including capitation, fee for service, or per diem as needed. Provides information related to determine the performance of TCHP’s contracts.  
  • Improves productivity within TCHP by further developing processes to manage data in the most accurate and efficient manner. Facilitates the automation and improvement of TCHP Finance departmental processes. Provides the framework to allow cross training. Trains on in-house programs and systems. (TSI, R&R, Data Import, Access, Peoplesoft) Participates in computer classes to improve skills and learn new programs.  
  • Works closely with fellow employees and management at TCHP and contractual contacts to stay on top of issues arising from daily activity. Contributes to promoting an atmosphere of team-orientation through demonstrating a positive, flexible, and customer service attitude. Maintains a willingness to seek out answers in a constantly changing environment. Contacts and takes the initiative to handle any variations outside of the normal flow of business. 

Skills & Requirements 

  • Being fully vaccinated against COVID-19, including any booster dose(s) of the COVID-19 vaccine recommended by the Centers for Disease Control when eligible, is required for all employees at Texas Children’s unless approved for a medical or religious exemption. 
  • Required Bachelor's Degree Business Administration, Accounting and/or Finance 
  • Required 1 year Financial or accounting experience 
  • A Master’s degree in Finance, Accounting or Business Administration or a Certified Public Accountant (CPA) license may substitute for the one (1) year of required experience 

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