Manager, Medical Economics Tooling

This is a fully remote position, open to applicants in United States.

📋 Description

• Create and develop dashboards, business-intelligence solutions, reusable metric logic, curated datasets, recurring analyses, and automation.

• Utilize BI and data-development tools, including SQL, Python, or similar coding languages, to enhance transparency and actionability of medical cost, utilization, membership, risk, and financial performance.

• Convert stakeholder requirements into precise technical designs.

• Transform approved actuarial and health-insurance methodologies into sustainable analytical solutions.

• Maintain approved definitions, denominators, completion methods, risk-adjustment conventions, and financial tie-outs.

• Take ownership of complex solutions through all phases from requirements gathering, prototyping, development, testing, user acceptance, deployment, monitoring, maintenance, to enhancement.

• Make informed technical decisions that balance speed, usability, reusability, reliability, and maintainability.

• Collaborate with Medical Economics, Actuarial, Finance, Data, BI, operational, and business stakeholders.

• Identify target audiences and success metrics, prioritize requirements, manage dependencies, and navigate trade-offs.

• Enhance validation, code review, and documentation standards.

• Ensure data accuracy, cross-product, and financial tie-outs; implement release controls and change management processes.

• Formulate plans for replacing or retiring legacy assets.

• Spot suitable opportunities for reusable AI-enabled workflows.

• Review designs and code, guide matrixed contributors, and provide mentorship to colleagues.

• Communicate completed solutions and insights through regular operational and executive readouts.

• Represent Medical Economics in cross-functional discussions.

• Raise significant roadmap conflicts, dependencies, and decisions that require leadership alignment.

• Report to a Senior Director within the Medical Economics department.

• Execute other duties as assigned.

⛳️ Requirements

• Bachelor’s degree in a quantitative or technical discipline.

• Over 5 years of experience in quantitative analysis, business intelligence, actuarial, Medical Economics, healthcare data, or a related field; and/or considerable experience in health insurance or another payer environment.

• Comprehensive understanding of medical claims and healthcare coding, including CPT/HCPCS, ICD-10, and DRGs.

• Familiarity with pharmacy, authorization, membership, premium, risk adjustment, completion, or financial-performance data.

• Advanced hands-on expertise in SQL.

• Proficiency in at least one general-purpose programming language, such as Python.

• Adherence to all applicable laws and regulations.

• Candidates must reside in the U.S., excluding Alaska, Delaware, Hawaii, Louisiana, Montana, North Dakota, Oklahoma, West Virginia, Wyoming, and U.S. Territories.

• Bonus: advanced skills in quantitative problem-solving, coding, technical design, and complex healthcare or financial concepts.

• Bonus: experience managing complex decision-support solutions from initial requirements through to launch and maintenance.

• Bonus: experience in designing, building, deploying, and operating dashboards, recurring analyses, data products, or shared metric content.

• Bonus: familiarity with software-development practices including version control, modular and reusable code, code review, automated testing, release controls, and technical documentation.

• Bonus: ability to translate ambiguous business needs and quantitative methodologies into technical designs, data models, component boundaries, priorities, and delivery plans.

• Bonus: experience leading efforts across multiple teams or matrixed contributors.

• Bonus: experience with modern BI or visualization platforms such as Looker, Tableau, or Power BI.

• Bonus: knowledge of data-transformation frameworks, workflow orchestration, CI/CD or release automation, and performance or reliability optimization.

• Bonus: experience with governed metric definitions, shared dimensions and measures, monitoring, or shared quantitative infrastructure.

• Bonus: familiarity with AI-assisted or large-language-model tools for software development, data analysis, or insight generation.

• Bonus: Associate or Fellow of the Society of Actuaries, or progress toward an SOA credential.

🏝️ Benefits

• Employee benefits.

• Oscar's unlimited vacation program.

• Annual performance bonuses.

• Medical benefits.

• Dental benefits.

• Vision benefits.

• 11 paid holidays.

• Paid sick time.

• Paid parental leave.

• Participation in a 401(k) plan.

• Life insurance.

• Disability insurance.

• Paid wellness time.

• Wellness reimbursements.

• Occasional travel for team meetings and company events.