Medical Economics Analyst

Job ID: J161051
Company: Gateway Health Plan
Location: Pittsburgh,PA,US
Full/Part Time: Full time
Job Type:
AHN Facility:
Posted Date: April 29, 2020

JOB DESCRIPTION

Company :

Gateway Health Plan

Job Description :

JOB SUMMARY

This job is responsible for analyzing emerging medical cost trends, develops medical cost analytics, builds analytics models, and tracks outcomes related to the initiatives focused on medical costs. The incumbent leverages medical economics processes, tools, and reporting. The incumbent also supports the team to help business leaders link their programs with financial plans/forecasts, emerging results, and outcomes. Additionally, the incumbent builds business segment medical economic analytics to help tell the story of emerging financial results. Incumbent must demonstrate a high-level of analytical, communication, and influencing skills.

ESSENTIAL RESPONSIBILITIES

  • Analyze emerging medical cost trends to understand the larger medical cost picture to provide timely insight into claim cost drivers for the business segment leaders and identification of new improvement opportunities.
  • Use medical economics and analytical experience and knowledge to facilitate idea generation and quantification of savings initiatives in areas of focus, such as provider contracting, utilization management, care management, risk adjustment, operational efficiencies, product design, etc.
  • Influence other departments without direct authority in coordination with other team members.  Determine when projections seem unreasonable and constructively push back until satisfied with the analysis.
  • Consistently work with Health Plan business and functional area partners to develop a pipeline of new initiatives, seeking to achieve our multi-year financial improvement targets. Help drive a culture change from “reporting the past” to “creating the solutions for future.”  
  • Develop improved business case and savings estimate capabilities to enable more accurate and deeper projections.
  • Other duties as assigned or requested.

EDUCATION

Required

  • Bachelor’s Degree in Business Administration, Business Management, Economics, Mathematics, Actuarial Science, Finance, or Accounting

Substitutions

  • None

Preferred:

  • None

EXPERIENCE

Required

  • 3 years of progressive experience in Medical Economics, Healthcare Underwriting, Finance, Accounting, or Analytics

Preferred

  • 3 years of progressive experience with SAS/SQL or other data querying and analytics experience
  • Experience creating Tableau reports
  • Experience engaging with upper management and/or senior level leadership
  • Proven experience and ability to lead in matrixed work environment

LICENSES & CERTIFICATIONS

Required

  • None

Preferred

  • None

SKILLS

  • Medical Economics   
  • Underwriting   
  • Financial Analysis/Modeling   
  • Communication   
  • Collaboration across a matrix-environment   
  • SAS/SQL or other data querying experience   

Travel Required

0% – 25%

Language Required (other than English)

None

PHYSICAL, MENTAL DEMANDS, AND WORKING CONDITIONS

Position Type

Office Based

Teaches / trains others regularly

Occasionally

Travel regularly from the office to various work sites or from site-to-site

Rarely

Works primarily out-of-the office selling products/services (sales employees)

Never

Physical work site required 

Yes

Lifting: up to 10 pounds

Constantly

Lifting: 10 to 25 pounds

Rarely

Lifting: 25 to 50 pounds

Rarely

Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job.

Compliance Requirement: This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies.
 

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Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities, and prohibit discrimination against all individuals based on their race, color, religion, sex, national origin, sexual orientation/gender identity or any other category protected by applicable federal, state or local law. Highmark Health and its affiliates take affirmative action to employ and advance in employment individuals without regard to race, color, religion, sex, national origin, sexual orientation/gender identity, protected veteran status or disability.

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BENEFITS

Total Rewards Program

In addition to competitive pay rates and flexible career growth, we show our employee appreciation through a comprehensive Total Rewards package, including:

  • Medical and prescription drug, dental and vision coverages for your and your eligible dependents
  • Health Saving and Flexible Spending Accounts
  • Life, AD&D and disability insurance
  • Employer-sponsored 401(k) plan
  • Paid time off, including paid holidays
  • Tuition reimbursement
  • Volunteer opportunities
  • Voluntary benefits
  • Employee discounts
Wellness Resources and Programs
Employees have access to the following wellness programs and resources:
  • Work-life resources, such as employee assistance programs and financial counseling services
  • 24/7 telephone access to health and wellness coaching to achieve personal goals
  • Onsite pharmacy services at major campuses
  • Fitness center access for all employees inclusive of showers, lockers, and group exercise classes at major Highmark campuses, Allegheny General Hospital & West Penn Hospital
  • Access to chronic condition management programs when enrolled in the employer-sponsored medical plan
  • 100% coverage for preventive exams, including flu shots
  • Incentive program that rewards employees
  • Secure bicycle parking at major campuses
  • Healthy food options at onsite cafeterias
  • Employee networks to gather in the name of health
  • Onsite seated massage and stress management classes including yoga, mindfulness and meditation

LIVING IN PITTSBURGH

Pittsburgh, PA is home to Highmark Health’s corporate headquarters, as well as the headquarters of many of our businesses and a majority of our career opportunities. When you live and work in Pittsburgh, you’ll experience a wide variety of lifestyle advantages. Take a look around and you’ll quickly see why Pittsburgh is one of America’s most liveable, most affordable, safest and happiest cities. Learn more about this exciting and inviting location:

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