Analyze complex medical claims, pharmacy data, and other healthcare data sets to identify emerging cost and utilization trends, patterns, and outliers.
Develop financial models to evaluate the financial impact of new clinical programs, new initiatives, and value-based agreements.
Identify opportunities for medical cost reduction, quantify potential savings, and measure the return on investment (ROI) of implemented initiatives.
Create clear, concise reports, dashboards, and presentations using data visualization tools to communicate complex findings and actionable insights to a variety of stakeholders, including senior management and clinical departments.
Work closely with accounting, actuarial, underwriting, clinical, health services delivery and network management teams to provide analytical support for decision-making and strategic planning, such as informing payer negotiations and risk adjustment strategies.
Ensure the accuracy and integrity of data used in analyses, and prepare well-organized project documentation including methodologies and key decision points.
Respond to ad-hoc data analysis requests from various departments, providing timely intelligence related to specific business problems.

Bachelor’s degree in Economics, Statistics, Finance, Public Health, Mathematics, Actuarial Science, Data Analytics or related quantitative discipline required.
1-3 years of progressive analytical experience in a healthcare setting (health insurance, managed care, or health system) is required.
Knowledge of STARs and Risk Adjustment preferred.
Strong analytical, problem-solving, critical thinking, and communication skills are vital for success in this role.
Proficiency in SQL for data extraction and manipulation is a must.
Advanced Microsoft Excel skills, including pivot tables and complex formulas, are essential.
Experience with data visualization tools like Tableau or Power BI is highly valued.
Familiarity with statistical tools such as SAS, R, or Python is often a plus.

Medical Economics Analyst – Health Plan

Key skills