[Hiring] Medical Economics Analyst @Horizon Blue Cross Blue Shield of New Jersey

Role Description

The position is primarily responsible for driving and producing various financial reporting and analytical activities that support Healthcare Management's P&L evaluation on routine basis that lead to key medical cost savings action plans. Key focus areas include developing a detailed understanding of the composition of monthly and year-to-date revenue and medical cost, including identifying the key variance factors between Actual results and Budget. In addition, this position will also have responsibility within Value Based Program analytics, Alliance/Value Based Program Partner presentation development and the coordination and completion of the HCM Monthly Operating Review (MOR). This includes, but is not limited to aspects of medical cost performance including utilization, unit cost, vendor programs and value-based reimbursement.

What You'll Do

• Works within Health Care Management to provide analysis to inform the strategic focus for the identification and implementation of network and medical cost management strategies.
• Develops and monitors a series of metrics and reports related to medical cost performance.
• Works closely with the Value Based Program team to understand the operations of the program including attributed membership and shared savings calculations and supports the integrity of the Program through objective review and validation.
• Develops and leads key Healthcare Management Reporting on a monthly basis aimed at the presenting and understanding of specific HCM P&L performance including:
  • Variance Analysis/Commentary Actual vs Budget/Plan and Prior Year
  • Revenue detail and components
  • Medical Cost detail and components
  • Product Mix
  • Market Segments
• Leads the coordination and consolidation of the HCM Monthly Operating Review (MOR).
• Gathers and utilizes analytics from multidisciplinary teams to develop and evaluate the performance of existing medical cost activities across Health Care Management and consults with business leaders on observations and recommendations.
• Provide support to the Value Based Program analytics initiatives through data mining and extraction, report and presentation design, financial modeling, identification of medical cost trend drivers, and consolidation of medical action plans.
• Implement analytic tools and techniques to identify cost drivers and ways to improve medical cost performance.
• Evaluates the feasibility of strategic initiatives and new business opportunities, providing support in developing financial program scenarios for current and potential Value Based Program partners related to program evolution or customization.
• Actively participates within the development of the future state of Value Based Programs.
• Works in multidisciplinary teams to identify, quantify return on investment, and track medical cost reduction initiatives, coordinating with finance and actuarial team to connect medical cost activities to the enterprise financial process.

Qualifications

• High School Diploma/GED required.
• Bachelor degree in accounting or finance preferred or relevant experience in lieu of degree.
• Minimum of 3-5 years of experience in health care/managed care with direct responsibility within a Financial Planning & Analysis (FP&A) and/or Medical Cost Management & Analysis discipline.
• Progressive understanding of managed care business processes, data, systems, and applications for claims payment, enrollment, benefit design, product pricing, network and provider contracting, and utilization management.
• Experience working closely with business partners such as Analytics, Actuaries and/or FP&A.

Requirements

• Solid understanding of P&L management principles, actual versus budget variance analysis, and general knowledge of budgeting and planning principles.
• General knowledge of the components underneath medical cost and utilization trends, and how to appropriately present year-over-year comparisons to identify variances/changes to budget and prior year.
• Knowledge of Commercial and Medicare market sectors and products.
• Knowledge of healthcare/managed care industry operations and products and how they relate to key metrics within financial statements.
• Proven quantitative and financial analysis skills.
• Ability to express thoughts clearly and concisely, both verbally and in writing.
• Demonstrated aptitude for analytical thinking and the ability to report findings accurately.
• Ability to research and resolve problems through interaction with company-wide personnel.
• Process mapping capabilities to develop new methodologies to achieve desired results.
• Ability to work independently with minimal direct supervision and exercise sound business judgment.
• Direct knowledge, or the ability to learn quickly Horizons Accounting and Financial Planning & Analysis (FP&A) platforms (e.g., Lawson General Ledger system, Hyperion Planning).
• Advanced knowledge of Excel.
• Experience with Word and PowerPoint.
• Technical skills with database concepts, data analysis development, data warehousing, and data extraction tools (e.g., SQL).

Benefits

• Comprehensive health benefits (Medical/Dental/Vision)
• Retirement Plans
• Generous PTO
• Incentive Plans
• Wellness Programs
• Paid Volunteer Time Off
• Tuition Reimbursement

Company Description

Horizon Blue Cross Blue Shield of New Jersey empowers our members to achieve their best health. For over 90 years, we have been New Jersey’s health solutions leader driving innovations that improve health care quality, affordability, and member experience. Our members are our neighbors, our friends, and our families. It is this understanding that drives us to better serve and care for the 3.5 million people who place their trust in us. We pride ourselves on our best-in-class employees and strive to maintain an innovative and inclusive environment that allows them to thrive. When our employees bring their best and succeed, the Company succeeds.