Medical Economics Consultant

Company :

Job Description : 

JOB SUMMARY

This job is responsible for the financial reporting of Highmark’s strategic cost of care savings program. The ideal candidate will be comfortable gathering financial data from multiple business partners, performing quality checks on the data, performing financial analysis on the data and creating the executive leadership financial report.   The incumbent will have proven detailed technical and analytical experience with strong communication and influencing skills. More specifically, the candidate will take ownership of delivering a high-quality financial report with key insights on the emerging program impact to the health plan. Someone with an eye for detail and a drive to continuously improve processes is preferred. Using data driven analytics, the ideal candidate will: 1) develop dashboards and reports showing total program impact to the health plan, 2) track the outcomes of the programs, and 3) provide strategic insight into areas of focus/opportunities.

ESSENTIAL RESPONSIBILITIES

• Provide strategic/tactical insights into emerging medical cost trends.  Develop executive ready presentations explaining analytical findings in a clear concise manner.   
• Proficiency to extract, summarize and analyze large datasets via SAS, SQL or other similar tools.
• Provide business areas with opportunity assessments of their strategic medical cost programs. Coordinate savings opportunity projections and post implementation savings measurements. Develop improved business case and savings estimate capabilities to enable more accurate and deeper projections.
• Leverage analytical experience and knowledge to drive independent medical cost analytics; develop areas of opportunity using a fact-based analysis, present medical cost analytics and insight into claim cost drivers to key business partners.
• Strong communication skills (verbal and executive quality presentations) to present clear, concise presentations of the detailed analytics.
• Work in a matrixed work environment. Partner with other departments in developing the full analytical story.
• Other duties as assigned or requested.

EDUCATION

Required

• Bachelor's Degree in Business, Health, Economics, Mathematics/Actuarial Sciences or other related area

Substitutions

• None

Preferred

• Master's Degree in Business, Health, Economics, Mathematics/Actuarial Sciences or other related area

EXPERIENCE

Required

• 5 years of Medical Economics, Healthcare Analytics, Informatics and/or Actuarial Services in the health care payer sector

Preferred

• Strong coding background (R, R Shiny, Python, SQL, etc.). Experience building dashboards in Tableau, Power BI, or R Shiny.

LICENSES AND CERTIFICATIONS

Required

• None

Preferred

• None

SKILLS

• Proven analytical ability to drive independent work and meet business timelines and outcomes.
• Strong Technical Data Skills (SAS / SQL, R, Tableau, Excel, etc.)
• Demonstrated ability to work with business partners in communicating outcomes, partnering on analytics, and developing new approaches to breaking down a strategic hypothesis.
• Experience in the healthcare Industry, with solid knowledge of emerging trends and challenges

Languages (Other then English)

None

Travel Required

0% - 25%

PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS

Position Type

Hybrid or Remote - if you live within 50 miles of an office you are required to be onsite 3 days a week. T, W, Th.

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

Never

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 position adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies.

As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company’s Handbook of Privacy Policies and Practices and Information Security Policy. Furthermore, it is every employee’s responsibility to comply with the company’s Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements. 

Pay Range Minimum:

Pay Range Maximum:

Base pay is determined by a variety of factors including a candidate’s qualifications, experience, and expected contributions, as well as internal peer equity, market, and business considerations.  The displayed salary range does not reflect any geographic differential Highmark may apply for certain locations based upon comparative markets.

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 any category protected by applicable federal, state, or local law.

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