Medical Economics Analyst

Essential Functions Leads or participates in complex medical economic projects (e.g., medical cost savings, trend, and risk assessmentinitiatives) including identification and completion of key deliverables. Apply statistical analysis methods to develop, validate, and execute algorithms, statistical models, and reporting tools thatanswer 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 healthinsurer 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 resultsand 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 makeappropriate 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.EDUCATION Bachelor’s degree preferred. Undergraduate degree in math/actuarial, business, finance, or related field preferredExperienceHealthcare 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. Medicaleconomics 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 analyticsExperience with reporting tools such as Power BI (or similar)Advanced skills in Microsoft Excel; working knowledge of Word, PowerPoint, and AccessPreferred:Experience with actuarial analysis and methodologiesAbilities 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 subjectmatter 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 prioritiesSkills General business/demonstrated business and industry acumen General business/turning data into information Finance/delivering profit and performance ENVIRONMENTAL WORKING CONDITIONS Normal office environment or remote Some travelPHYSICAL/MENTAL DEMANDS Requires sitting and standing associated with a normal office environment. Some bending and stretching are required. Manual dexterity using a computer keyboard, phone, and scanner.ORGANIZATIONAL REQUIREMENT HOPCo Mission, Vision, and Values must be read and signed.This description is intended to provide only basic guidelines for meeting job requirements. Responsibilities, knowledge, skills,abilities, and working conditions may change as needs evolve.