Associate Director Medex/DW Healthcare Economics - Remote

UnitedHealth Group•Worcester, MA

16d•Remote

About The Position

For those who want to invent the future of health care, here's your opportunity. We're going beyond basic care to health programs integrated across the entire continuum of care. Join us to start Caring. Connecting. Growing together. Position in this function is under executive direction, the Associate Director Medex/DW Healthcare Economics Optum Massachusetts is responsible for all aspects of assessing, evaluating, and estimating outside medical expenses and claims data warehouse for Optum Massachusetts. Responsible for complex trend analysis and reporting to inform senior management’s decision making regarding the level of changes for financial statement reporting. Makes recommendations and provides critical professional expertise to inform senior management of amounts to record in the financial statements. Assesses and ensures the integrity, accuracy and consistency of the financial and utilization reports and databases and leads action plans for making improvements. Manages staff, consisting primarily of financial analysts. As the accountable business owner, oversees the implementation of changes to the databases, reports, and processes as dictated by changes in business needs to support the recording of outside medical expenses in the financial statements. You’ll enjoy the flexibility to work remotely from anywhere within the U.S. as you take on some tough challenges. For all hires in the Minneapolis or Washington, D.C. area, you will be required to work in the office a minimum of four days per week.

Requirements

Bachelor’s degree (or equivalent experience) required, preferably in accounting, finance, mathematics or actuarial science
5+ years of experience in financial data analysis including experience in a managerial, supervisory or lead role
Experience in healthcare or health insurance
Proven background in financial modeling and forecasting
Proven solid computer skills including Microsoft Excel and SQL, and experience in computer-based modeling
Proven excellent analytical and quantitative skills including statistical analyses
Proven detail oriented with strong technical writing, communication, and presentation skills
Proven ability to build relationships and negotiate with external (payers and providers) and internal (finance, contracting, medical management, data warehouse) customers and develop a strong case for positive financial and other outcomes
Demonstrated project management skills and attention to detail
Demonstrated ability to work standard business hours in EST zone

Nice To Haves

MBA
Actuarial Certification
Knowledge of provider/facility contracting
Experience in a supervisory or lead role

Responsibilities

Oversees all aspects of calculation of outside claims expense and related reserves under hospital and payer risk contracts. Has overall responsibility for monthly calculation of expenses, liabilities, and accounts receivable related to payer risk contracts
Manages the monthly process of outside medical expense projections, the population of reporting and analytic databases, and the required reporting and analysis of inpatient and outside utilization expenses
Performs the monthly analytic review and interprets enterprise-wide, and site specific, trends and variances. Based on this analysis, makes critical recommendations to leadership on amounts to record in the monthly financial statements. Develops new financial and utilization reports and analyses as needed
Responsible for supporting all amounts recorded by accounting and ensuring that proper financial controls are in place to verify amounts recorded
Partners with business leaders and build strong relationships in support of financial performance; acts as a strategic thought-partner for the business
Drives intersegment agreements between Optum Massachusetts and UHC entities along with understanding the financial impacts
Responsible for: quarterly forecasts of all outside medical expense accounts, and related deliverables (i.e, bridges, trend reporting, supplemental schedules as applicable); Atrius forecast model for medical expense rates; creation of trends to ascertain year over year changes, experience, etc.
Partners across Optum Massachusetts Finance team to help lead integration activities.
Manages the monthly preparation of complex payer medical expense trend analyses for discussion at monthly financial statement meetings
Provides recommendations on inpatient and outside utilization expense levels and directs the creation of monthly journal entry to record outside medical cost
Develops and maintains on-going relationships with outside providers, payers and other external parties regarding data feeds, outside provider discounts and reinsurance issues. Directs the calculations and reconciliations of risk-sharing settlements with payers and hospitals. Has responsibility for contractually required medical claims expense and utilization reporting under risk-sharing arrangements with hospitals
Works directly with the actuaries and outside auditors on evaluation of the sufficiency of recording for hospital and outside utilization expense. As the expert, provides detailed support to auditors for the purpose of their actuarial assessments. Monitors amounts recorded against claims “run-out”. Works with financial auditors to validate medical claims expense and liabilities under payer and hospital risk contract/risk-sharing arrangements
In the business owner role, contacts payers to enable the data warehouse to be populated with accurate and correct data. Has responsibility for the calculation and monitoring of claims liability reserves from prior years’ risk arrangements
Provides financial expertise and recommends support to clinical leadership initiatives to manage outside medical expenses by providing expertise in valuing the potential savings impact of initiatives; by communicating cost trends; and adding expertise based on claims knowledge on how performance can be tracked. Has responsibility for monthly outside medical claims utilization and expense reporting
Provides leadership bridge between external and internal services of medical expertise information. Provides business rules for IT analysts to program accurate translation of monthly and annual payer data files needed to populate the enterprise data warehouse. This data warehouse is the key data repository necessary for monitoring and reporting of outside medical costs
Administers all medical cost/managed care analytics related to capitated arrangements with insurances including Purchased Services and the production of all routine reports, General Ledger entries, lag grids, quarterly invoices, projections, budget and all requested ad hoc analyses. Responsible for maintenance and audit of the related claims information in the performance analytics system (DMS)
Works collaboratively with Contracting to provide data, analytic support, and expertise in support of payer and hospital risk management negotiations. Recommends proposals to Contracting. Supports Contracting Department discussions and evaluation of managed care contract terms; may propose changes in the contracts to the Contracting Department Leadership. Provides input and information to facilitate successful payer negotiations on expense trends and payer financial performance; works closely with the Contracting Department to estimate and manage the preparation of detail settlement documents for recovery of funds based on contractual arrangements with payers and hospital risk-sharing partners. Responsible for reconciling outside medical expenses associated with annual and interim settlements of the capitation risk contracts. Works collaboratively with the Controller to reach agreement on the final annual contract financial results
In conjunction with senior management, collaborates on the annual hospital and outside utilization budgets and year-end/multi-year projections, including managing complex provider discounts and reinsurance. Directs pharmacy trend analysis related to the managed care contracts and supports understanding of these trends relative to in-house and network pharmacy expenses
Manages and oversees the relationship with outside reinsurance broker and provides information according to contractual requirements. Participates in the evaluation of new reinsurance coverages and makes recommendations for program improvements
Working closely with Data Analytics and Data Warehouse leadership to support data quality initiatives and direct management of transitions of payer data from new contracts or changes in contractual terms. Serves as a primary source of business expertise for Data Warehouse and Data Analytics teams
Develops, on an as-needed basis, estimations of outside medical expenses for evaluation of new ventures and affiliations
Performs other duties as assigned