Medical Economics Analyst – Health Plan

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

📋 Description

• Evaluate intricate medical claims, pharmacy information, and various healthcare datasets to pinpoint emerging trends in costs and utilization, as well as anomalies.

• Construct financial models to assess the financial implications of new clinical programs, initiatives, and value-based agreements.

• Discover opportunities for reducing medical expenses, estimate potential savings, and assess the ROI of initiatives that have been implemented.

• Generate reports, dashboards, and presentations utilizing data visualization tools.

• Convey findings and actionable insights to senior management and clinical departments.

• Work in collaboration with accounting, actuarial, underwriting, clinical, health services delivery, and network management teams.

• Offer analytical support for strategic planning and decision-making, including payer negotiations and risk adjustment strategies.

• Ensure the accuracy and integrity of the data utilized in analyses.

• Compile project documentation, encompassing methodologies and key decision-making points.

• Address ad-hoc data analysis requests from various departments.

⛳️ Requirements

• A Bachelor’s degree in Economics, Statistics, Finance, Public Health, Mathematics, Actuarial Science, Data Analytics, or a related quantitative field is required.

• 1-3 years of progressive analytical experience within a healthcare environment (health insurance, managed care, or health system) is required.

• Familiarity with STARs and Risk Adjustment is preferred.

• Strong skills in analytical thinking, problem-solving, critical thinking, and communication are essential.

• Proficiency in SQL for data extraction and manipulation is necessary.

• Advanced skills in Microsoft Excel, including pivot tables and complex formulas, are required.

• Experience with data visualization tools such as Tableau or Power BI is highly regarded.

• Knowledge of statistical tools like SAS, R, or Python is considered a plus.

🏝️ Benefits

• Comprehensive health insurance coverage.

• Retirement savings plan with employer matching.

• Opportunities for professional development and advancement.

• Flexible work arrangements and a supportive work environment.