Medical Economics Analyst

This is a fully remote position, open to applicants in Connecticut, +3 more states.

📋 Description

• Conduct analyses to guide strategic initiatives in network and medical cost management.

• Create and oversee metrics and reports related to medical cost performance.

• Comprehend membership attribution and shared savings calculations, ensuring the integrity of Value-Based Programs through objective reviews and validation.

• Design and manage monthly Healthcare Management reports that include variance analysis, revenue, medical costs, product mix, and market segments.

• Organize and consolidate the Healthcare Management Monthly Operating Review (MOR).

• Collect multidisciplinary analytics to assess medical cost activities and provide insights and recommendations to business leaders.

• Assist in Value-Based Program analytics through data mining, extraction, report and presentation creation, financial modeling, identifying medical cost trend drivers, and consolidating medical action plans.

• Apply analytic tools and methodologies to uncover cost drivers and enhance medical cost performance.

• Assess strategic initiatives and new business opportunities, including financial program scenarios for Value-Based Program partners.

• Engage in shaping the future of Value-Based Programs.

• Collaborate with multidisciplinary teams to calculate return on investment and monitor medical cost reduction initiatives.

• Liaise with finance and actuarial teams to align medical cost activities with the enterprise financial processes.

⛳️ Requirements

• High School Diploma or GED is mandatory.

• A Bachelor’s degree in accounting or finance is preferred, or relevant experience may be accepted in lieu of a degree.

• At least 3-5 years of experience in healthcare/managed care with direct responsibilities in Financial Planning & Analysis (FP&A) and/or Medical Cost Management & Analysis.

• A progressive understanding of managed care business processes, data, systems, and applications related to claims payment, enrollment, benefit design, product pricing, network and provider contracting, and utilization management.

• Experience collaborating with Analytics, Actuaries, and/or FP&A on medical cost analyses, market segment premium development, monthly financial reporting and variance analysis, as well as annual business plan/budget creation and management presentations.

• Strong grasp of P&L management principles, actual versus budget variance analysis, and budgeting and planning concepts.

• Familiarity with medical cost and utilization trends and year-over-year comparisons.

• Knowledge of the Commercial and Medicare market sectors and their products.

• Insight into healthcare/managed care industry operations, products, and financial metrics.

• Proven skills in quantitative and financial analysis.

• Excellent verbal and written communication skills.

• Strong analytical thinking and precise reporting capabilities.

• Problem-solving skills through interactions with company personnel across departments.

• Competence in process mapping.

• Ability to work autonomously with minimal supervision while exercising sound business judgment.

• Direct experience or a quick learning ability with Horizon's Accounting and FP&A platforms, including Lawson General Ledger and Hyperion Planning.

• Advanced proficiency in Excel.

• Familiarity with Word and PowerPoint.

• Technical expertise in database concepts, data analysis development, data warehousing, and data extraction tools such as SQL.

• Candidates must reside in New Jersey, New York, Pennsylvania, Connecticut, or Delaware.

🏝️ Benefits

• Comprehensive health benefits (Medical/Dental/Vision).

• Retirement Plans.

• Generous Paid Time Off (PTO).

• Incentive Plans.

• Wellness Programs.

• Paid Volunteer Time Off.

• Tuition Reimbursement.