Remote Medical Economics Analyst

Overview

This role involves leading or participating in complex medical economic projects, applying statistical analysis to develop and validate algorithms, statistical models, and reporting tools, and producing medical cost trend analytics and forecasts for health insurer and risk-bearing provider clients. Work is completed cross-functionally and requires clear communication of complex information to multiple levels within the organization.

Responsibilities

• Lead or participate in complex medical economic projects, including identification and completion of key deliverables (e.g., medical cost savings, trend, and risk assessment initiatives).
• Apply statistical analysis methods to develop, validate, and execute algorithms, statistical models, and reporting tools that answer applied research and business questions for internal and external clients.
• Provide medical cost trend analytics, assess variance to expectations, and determine forecasted contract terms for health insurer and risk-bearing provider clients.
• Recommend data collection methods, define metrics, and establish evaluation methods.
• Develop studies, analyses, and presentation materials to inform decision makers.
• Present results and recommendations to management across VBC teams.
• Work cross-functionally to help achieve operational targets.
• Present complex information clearly so multiple levels of stakeholders can understand and utilize it to make appropriate decisions.
• Ensure project commitments to quality and on-time deliverables.
• Create and evaluate data needs for assigned projects and assure data integrity.
• Work independently to plan and conduct sophisticated analyses.
• Other duties as assigned.

Education

• Bachelor’s degree preferred.
• Undergraduate degree in math/actuarial, business, finance, or related field preferred.

Experience

• 3+ years in health insurance, value-based care, or healthcare administration.
• 2+ years analyzing healthcare claims and eligibility data, including:
  • Medical cost, trend, and variance analysis
  • Identification of cost management opportunities
  • Medical economics analysis and reporting
  • Statistical analysis and data modeling
• 2+ years analyzing capitated and fee-for-service provider contracts across:
  • Medicare
  • Medicare Advantage
  • Commercial
  • Medicaid

Technical Skills

• 2+ years working with database management systems (e.g., SQL Server, DB2, SAS).
• Proficiency in SQL and healthcare data analytics.
• Experience with reporting tools such as Power BI (or similar).
• Advanced skills in Microsoft Excel.
• Working knowledge of Word, PowerPoint, and Access.

Preferred Qualifications

• Experience with actuarial analysis and methodologies.

Abilities

• Proficiency in statistical methods of data analysis.
• Understanding of medical cost drivers and provider reimbursement methodologies.
• Strong problem solving, analytical, and project management skills.
• Demonstrated extensive and diverse knowledge of health care data, metrics, systems, and standards; demonstrated subject matter expert in multiple subject areas.
• Ability to make sound decisions and recommendations that drive business solutions.
• Ability to communicate statistical and technical ideas and results to non-technical clients.
• Ability to work independently and complete projects within established timeframes.
• Self-starter with the ability to juggle competing priorities.

Environmental Working Conditions

• Normal office environment or remote.
• Some travel.

Physical/Mental Demands

• Requires sitting and standing associated with a normal office environment.
• Some bending and stretching required.
• Manual dexterity using a computer keyboard, phone, and scanner.

Organizational Requirement

• Mission, Vision, and Values must be read and signed.