[Hiring] Medical Economics Analyst @Healthcare Outcomes Performance Co. (HOPCo)

Role Description

• 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.

Qualifications

• Bachelor’s degree preferred. Undergraduate degree in math/actuarial, business, finance, or related field preferred.

Requirements

• 3+ years in health insurance, value-based care, or healthcare administration.
• 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.
• 2+ years of experience analyzing capitated and fee-for-service provider contracts across:
  • Medicare, Medicare Advantage, Commercial, and Medicaid plans.
• 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.
• Preferred: Experience with actuarial analysis and methodologies.

Abilities

• 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.

Skills

• 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 travel.

Physical/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.