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.
- 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.
- Bachelor’s Degree in Business Administration, Business Management, Economics, Mathematics, Actuarial Science, Finance, or Accounting
- 3 years of progressive experience in Medical Economics, Healthcare Underwriting, Finance, Accounting, or Analytics
- 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
- Medical Economics
- Financial Analysis/Modeling
- Collaboration across a matrix-environment
- SAS/SQL or other data querying experience
0% – 25%
Language Required (other than English)
PHYSICAL, MENTAL DEMANDS, AND WORKING CONDITIONS
Teaches / trains others regularly
Travel regularly from the office to various work sites or from site-to-site
Works primarily out-of-the office selling products/services (sales employees)
Physical work site required
Lifting: up to 10 pounds
Lifting: 10 to 25 pounds
Lifting: 25 to 50 pounds
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.