Medical Economics Analyst, Health Plan

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

📋 Description

• Examine intricate medical claims, pharmacy data, and various healthcare datasets to uncover emerging cost trends, utilization patterns, and anomalies.

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

• Spot opportunities for reducing medical costs, estimate potential savings, and evaluate the return on investment (ROI) of initiatives that have been implemented.

• Generate clear and concise reports, dashboards, and presentations utilizing data visualization tools to convey complex findings and actionable insights to a diverse range of stakeholders, including senior management and clinical departments.

• Collaborate closely with teams in accounting, actuarial services, underwriting, clinical, health services delivery, and network management to offer analytical support for decision-making and strategic planning.

• Ensure the precision and integrity of data utilized in analyses, and prepare well-structured project documentation that includes methodologies and key decision points.

• Address ad-hoc data analysis requests from various departments, delivering timely insights related to specific business challenges.

⛳️ 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 progressively responsible analytical experience in a healthcare environment (such as health insurance, managed care, or health systems) is required.

• Familiarity with STARs and Risk Adjustment is preferred.

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

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

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

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

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

🏝️ Benefits

• Union Position: No

• Health Insurance