Senior Manager, Medical Cost Analytics

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

📋 Description

• Lead a team of analysts focused on Payment Integrity initiatives.

• Identify drivers of medical costs, trends, risks, and opportunities for affordability.

• Develop and implement analysis and AI to support enterprise-level Payment Integrity strategies.

• Foster alignment across various business units toward shared financial goals and priorities.

• Convert analytical results into insights suitable for executive presentations.

• Manage financial business cases, forecasts, variance analyses, and performance recommendations for affordability initiatives.

• Supervise analytics related to Payment Integrity initiatives, policy modifications, and ongoing performance evaluation.

• Evaluate reporting capabilities and enhance self-service analytics solutions using AI and tools like Databricks, Tableau, Claude, and Cursor.

• Modernize analytics through scalable methods, automation, and AI-driven tools.

• Conduct research on affordability, AI, and business trends to guide senior management on Payment Integrity strategies.

• Oversee and mentor analysts, establish priorities, ensure quality output, and support skill enhancement.

• Prioritize and allocate work across various initiatives.

• Implement data quality checks, controls, and processes.

• Identify insights, risks, and emerging trends to shape the affordability strategy.

• Collaborate with finance, operations, clinical, product, and network teams to analyze trends and support proposals.

⛳️ Requirements

• Bachelor’s degree or equivalent in a quantitative field such as Economics, Finance, Data Science or Analytics, Business, Applied Mathematics, Public Health, Actuarial Science, or similar.

• Over 7 years of progressive experience in medical claims predictive analytics, financial modeling, or healthcare economics.

• Experience as a People Leader.

• Strong analytical and technical expertise.

• Proficient in SQL, Excel, SAS, Databricks, Tableau, or similar platforms.

• Knowledge of medical claim coding and provider reimbursement processes.

• Ability to convert complex analyses into actionable business insights.

• Experience delivering presentations to senior and executive audiences.

• Proven ability to manage multiple priorities while leading teams in a matrixed environment.

• Strong focus on analytical accuracy.

• Capability to work independently and collaborate with cross-functional teams.

• Internet connection via cable broadband or fiber optic service with minimum speeds of 10Mbps download/5Mbps upload when working remotely.

🏝️ Benefits

• Eligibility for an annual bonus plan.

• Medical, vision, and dental benefits starting from day one.

• Access to well-being and behavioral health programs.

• 401(k) plan.

• Company-paid life insurance.

• Tuition reimbursement opportunities.

• Minimum of 18 days of paid time off each year.

• Paid holidays.

• Leaves of absence available.

• Flexible remote work arrangement.

• Requirement for cable broadband or fiber optic internet with at least 10Mbps download/5Mbps upload for home work.