Medical Economics Analyst, Health Plan

Overview

This role provides analytical support to help identify medical cost trends and evaluate financial performance to support strategic business decisions.

• Facility: Remote, WI
• Schedule: Full-time (40.00 hours/week)
• Salary Range: $29.00 - $46.50

Responsibilities

• Analyze complex medical claims, pharmacy data, and other healthcare datasets to identify emerging cost and utilization trends, patterns, and outliers.
• Develop financial models to evaluate the financial impact of new clinical programs, new initiatives, and value-based agreements.
• Identify opportunities for medical cost reduction, quantify potential savings, and measure the return on investment (ROI) of implemented initiatives.
• Create clear, concise reports, dashboards, and presentations using data visualization tools to communicate insights to senior management and clinical departments.
• Partner with accounting, actuarial, underwriting, clinical, health services delivery, and network management teams to support decision-making and strategic planning (including informing payer negotiations and risk adjustment strategies).
• Ensure the accuracy and integrity of data used in analyses.
• Prepare well-organized project documentation, including methodologies and key decision points.
• Respond to ad-hoc data analysis requests from various departments with timely, actionable intelligence.

Requirements

• Bachelor’s degree in Economics, Statistics, Finance, Public Health, Mathematics, Actuarial Science, Data Analytics, or related quantitative discipline (required).
• 1-3 years of progressive analytical experience in a healthcare setting (health insurance, managed care, or health system) (required).
• Proficiency in SQL for data extraction and manipulation (must have).
• Advanced Microsoft Excel skills, including pivot tables and complex formulas (essential).
• Strong analytical, problem-solving, critical thinking, and communication skills.

Preferred Qualifications

• Knowledge of STARs and Risk Adjustment.
• Experience with data visualization tools such as Tableau or Power BI.
• Familiarity with statistical tools such as SAS, R, or Python.

Compensation & Benefits

• Salary range: $29.00 - $46.50
• Offers a benefits package for qualifying full-time and part-time employees, with eligibility-dependent options including:
  • Health insurance
  • Dental insurance
  • Vision insurance
  • Life insurance
  • 401(k) retirement plan
  • Work/life balance benefits
  • Generous time off package

Location

• Remote, WI