JOB SUMMARY

We are seeking an experienced Medical Economics Analyst to join our healthcare analytics team. This role will focus on analyzing healthcare cost trends, evaluating medical cost reduction program effectiveness, and providing data-driven insights to support strategic decision-making in value-based care initiatives.

JOB SPECIFICATIONS

• Lead complex analyses of medical cost trends, utilization patterns, and medical cost savings program effectiveness.
• Design and execute measurement strategies for medical cost affordability initiatives.
• Evaluate financial and clinical outcomes of value-based contracting arrangements.
• Develop forecasting models to project future medical costs and program savings.
• Create and maintain dashboards to track key performance indicators.
• Partner with clinical and business teams to identify opportunities for medical cost reduction or optimization.
• Present findings and recommendations to senior leadership.
• Influence strategic decisions affecting medical cost management.
• Drive millions in potential savings through program evaluation.
• Support network optimization and value-based contracting.
• Contribute to annual budgeting and forecasting processes.
• Collaborate across departments including Finance, Clinical, and Operations.

QUALIFICATIONS:

• Education/Specialized Training/Licensure: Bachelors degree in mathematics, Economics, Statistics, Engineering, or related field required.
• Work Experience (Years and Area): 8 years of experience as a systems analyst, business analyst, in medical economics, or other related analytics function required.
• 5 years of professional experience in a healthcare organization required.
• Software Proficiencies: Excel, SQL Excel, MS SQL Server

Other:

• Strong understanding of healthcare payment models and medical cost drivers.
• Experience with claims data analysis and risk adjustment methodologies
• Expertise in statistical analysis and research design
• Demonstrated Ability to translate complex analyses into actionable insights
• Strong analytical and problem-solving abilities.
• Excellent project management skills.
• Clear written and verbal communication.
• Ability to work independently and in teams.
• Detail-oriented with strong quality control focus.
• Strategic thinking and business acumen.
• Experience with value-based program evaluation.
• Background or experience with actuarial analysis.
• Strong understanding of healthcare payment models and medical cost drivers.
• Experience with claims data analysis and risk adjustment methodologies
• Expertise in statistical analysis and research design
• Demonstrated Ability to translate complex analyses into actionable insights
• Strong analytical and problem-solving abilities.
• Excellent project management skills.
• Clear written and verbal communication.
• Ability to work independently and in teams.
• Detail-oriented with strong quality control focus.
• Strategic thinking and business acumen.

Reports to Position Title: Actuarial Director

COMPETENCIES

• Analytical Thinking
• Motivated
• Results Oriented
• Taking Initiative