Medical Economics Analyst
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Job Description
Medical Economics Analyst analyzing healthcare costs, P&L performance, and value-based programs for Horizon BCBSNJ. Developing financial reports, models, and cost-reduction initiatives.
Responsibilities:
- Provide analysis to inform strategic network and medical cost management strategies
- Develop and monitor metrics and reports related to medical cost performance
- Understand attributed membership and shared savings calculations and support Value Based Program integrity through objective review and validation
- Develop and lead monthly Healthcare Management reporting covering variance analysis, revenue, medical cost, product mix, and market segments
- Coordinate and consolidate the Healthcare Management Monthly Operating Review (MOR)
- Gather multidisciplinary analytics to evaluate medical cost activities and consult with business leaders on observations and recommendations
- Support Value Based Program analytics through data mining, data extraction, report and presentation design, financial modeling, identifying medical cost trend drivers, and consolidating medical action plans
- Implement analytic tools and techniques to identify cost drivers and improve medical cost performance
- Evaluate strategic initiatives and new business opportunities, including financial program scenarios for Value Based Program partners
- Participate in developing the future state of Value Based Programs
- Work with multidisciplinary teams to quantify return on investment and track medical cost reduction initiatives
- Coordinate with finance and actuarial teams to connect medical cost activities to the enterprise financial process
Requirements:
- 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 Analytics, Actuaries and/or FP&A on medical cost analysis, market segment premium development, monthly financial reporting and variance analysis, annual business plan/budget development and management presentations
- Solid understanding of P&L management principles, actual versus budget variance analysis, and budgeting and planning principles
- Knowledge of medical cost and utilization trends and year-over-year comparisons
- Knowledge of Commercial and Medicare market sectors and products
- Knowledge of healthcare/managed care industry operations, products, and financial statement metrics
- Proven quantitative and financial analysis skills
- Clear and concise verbal and written communication skills
- Analytical thinking and accurate reporting abilities
- Problem research and resolution skills through interaction with company-wide personnel
- Process mapping capabilities
- Ability to work independently with minimal direct supervision and exercise sound business judgment
- Direct knowledge or ability to quickly learn Horizon's Accounting and FP&A platforms, including Lawson General Ledger and 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 such as SQL
- Employees must live in New Jersey, New York, Pennsylvania, Connecticut or Delaware
Benefits:
- Comprehensive health benefits (Medical/Dental/Vision)
- Retirement Plans
- Generous PTO
- Incentive Plans
- Wellness Programs
- Paid Volunteer Time Off
- Tuition Reimbursement
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