Medical Economics Analyst

Healthcare Outcomes Performance Company•Phoenix, AZ

21h•Hybrid

About The Position

This role involves leading or participating in complex medical economic projects, such as medical cost savings, trend, and risk assessment initiatives. The analyst will apply statistical analysis methods to develop, validate, and execute algorithms, statistical models, and reporting tools to answer applied research and business questions for internal and external clients. Key responsibilities include providing medical cost trend analytics, assessing variances, and determining forecasted contract terms for health insurer and risk-bearing provider clients. The position requires making recommendations on data collection, metrics definition, and evaluation methods, as well as developing studies, analyses, and presentation materials for decision-makers. The analyst will present results and recommendations to management across Value-Based Care (VBC) teams and work cross-functionally to achieve operational targets. A crucial aspect of the role is presenting complex information in an understandable way for various organizational levels to facilitate informed decision-making. The analyst will be responsible for project commitments regarding quality and on-time deliverables, demonstrating a willingness to delve into technical details, and creating/evaluating data needs while ensuring data integrity. The role requires independent work to plan and conduct sophisticated analyses.

Requirements

Healthcare Industry Experience: 3+ years in health insurance, value-based care, or healthcare administration
Data & Analytical Expertise: 2+ years of experience 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
Contract & Product Knowledge: 2+ years of experience analyzing capitated and fee-for-service provider contracts across: Medicare, Medicare Advantage, Commercial, and Medicaid plans
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
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 to 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 and ability to juggle competing priorities
General business/demonstrated business and industry acumen
General business/turning data into information
Finance/delivering profit and performance

Nice To Haves

Bachelor’s degree preferred.
Undergraduate degree in math/actuarial, business, finance, or related field preferred
Experience with actuarial analysis and methodologies

Responsibilities

Leads or participates in complex medical economic projects (e.g., medical cost savings, trend, and risk assessment initiatives) including identification and completion of key deliverables.
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.
Makes recommendations about data collection methods, metrics definition, and evaluation methods.
Develops studies, analyses, and presentation materials needed to appropriately inform decision makers.
Presents results and recommendations to management across VBC teams.
Works cross-functionally throughout the organization toward achieving operational targets.
Presents complex information in a way that multiple levels within an organization can understand and utilize to make appropriate decisions to meet business objectives.
Responsible for project commitments to quality and on-time deliverables.
Willingness to understand and probe into technical details.
Creates and evaluates the data needs of assigned projects and assures the integrity of the data.
Works independently to plan and conduct sophisticated analyses.
Other duties as assigned.