Business Analytics Advisor - Healthcare Economics - EviCore

EviCore by Evernorth; Franklin (TN); Hybrid; USD 90,000 - 120,000; Full time

Job summary

EviCore by Evernorth seeks a Business Analytics Advisor to lead analysis of claims data, using BI tools and statistical methods. You will report to the Senior Manager and collaborate with Account Management, Finance, Informatics, Medical, Sales, and Marketing, including direct customer interactions.

The role emphasizes applying actuarial concepts, presenting findings clearly, and supporting new sales opportunities with data-driven insights. Remote work options may apply.

Qualifications

• BA/BS in finance, economics, statistics or related quantitative field.
• 8+ years analytic healthcare experience.
• Experience in ACO/IPA/MCO settings or bundled payments preferred.
• Experience with big data sources and SQL-based data extraction.

Responsibilities

• Oversee design, development, analysis and reporting of claims data.
• Use BI tools and statistical methods to reveal healthcare trends.
• Present results to technical and non-technical audiences.
• Support sales and product development with data-driven insights.

Skills

Healthcare analytics

SQL databases

Stakeholder communication

Education

BA/BS in finance/economics/statistics

Master's degree preferred

Tools

SQL data manipulation

Data warehousing

Job description

Position Summary

EviCore’s diversified portfolio of proven medical cost management solutions enables our clients to improve the quality and efficacy of care while at the same time reducing medical spend. We believe and have demonstrated that better healthcare is inherently less expensive.

We are looking for an individual with a background in medical, financial or actuarial analysis to join our Healthcare Economics team. The role of Business Analytics Advisor will be to oversee and assist in the design, development, analysis and reporting of claims data using business intelligence tools, statistical and analytical techniques to better understand healthcare trends, report on overall program results as well as identify opportunities in support of the sales team to expand our product offering to new and existing customers.

The Business Analytics Advisor will report to the Business Analytics Senior Manager and will work closely with our Account Management team, Finance, Informatics, Medical, Sales and Marketing staff, including direct involvement with customers in the form of written and verbal presentations to support corporate-wide strategic decision-making that impacts revenue, medical expense and product growth. The ideal candidate will come from a managed care, insurance, actuarial, or hospital background, and will be a results‑oriented individual who enjoys working in a fast‑paced and challenging environment.

Essential Functions

• Ability to influence internal stakeholders in order to accomplish objectives.
• Ability to present highly technical concepts to technical and non-technical audiences.
• Work with IT and data warehousing counterparts to develop and design deliverables to support the economics team and customer reporting needs. - Conduct baseline and trend analyses for targeted medical cost categories, geographies and segments.
• Calculate baseline and trend metrics (e.g., PMPM and Utilization per 1000).
• Apply actuarial concepts and tools to enhance understanding of utilization and cost trends across networks, products and geography.
• Validate findings against established benchmarks.
• Use baseline metrics and trends to establish Savings Forecast and Pricing.
• Creating and delivering results in an accurate and timely manner to both internal and external customers.
• Effectively communicate results to key stakeholders and policy makers. Communication of results include clean and well organized presentations to reflect analytic methods used, key decision points with sufficient detail to support comprehension and replication of the analysis.
• Provide additional analyses that support New Sales and Product Development by being able to manipulate and analyze claims data to perform IBNR calculations, Provider Network Overlap, Fee Schedule Pricing, trend mitigation and population mix-shifts.

Qualifications

• BA/BS degree (a Master’s degree is preferred) in finance, economics, statistics or other quantitative background.
• 8+ years of progressive, analytical experience in a healthcare setting.
• Experience working in an ACO, IPA or MCO setting and/or with bundled payments is a preferred.
• Knowledge of using big data and data warehouses, data extractions, manipulations, dimension, fact, and reference tables in order to obtain necessary information.
• Extensive experience using data directly from a SQL or similar database, not simply through a present reporting GUI.
• Strong understanding of managed care metrics (PMPM, Utilization/K and Average Cost).

If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload.

About Evernorth Health Services

Evernorth Health Services, a division of The Cigna Group, creates pharmacy, care and benefit solutions to improve health and increase vitality. We relentlessly innovate to make the prediction, prevention and treatment of illness and disease more accessible to millions of people. Join us in driving growth and improving lives.

Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws.

If you need a reasonable accommodation to complete the online application process, please email [e-mail] for assistance. Please note that this email inbox is dedicated to accommodation requests only and cannot provide application updates or accept resumes.

The Cigna Group has a tobacco‑free policy and reserves the right not to hire tobacco/nicotine users in states where that is legally permissible. Candidates in such states who use tobacco/nicotine will not be considered for employment unless they enter a qualifying smoking cessation program prior to the start of their employment. These states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, Pennsylvania, Texas, Utah, Vermont, and Washington State.

Qualified applicants with criminal histories will be considered for employment in a manner consistent with all federal, state and local ordinances.