Lead Medical Economics Analyst

Blue Cross & Blue Shield of Rhode Island; Providence (RI); Hybride; USD 102 000 - 164 000; Plein temps

Avantages offerts par ce poste

Flexible work options

Health, dental, vision insurance

Bonuses and investment plans

Tuition reimbursement

Paid time off

Résumé du poste

Blue Cross & Blue Shield of Rhode Island is seeking a Lead Medical Economics Analyst to act as a senior technical contributor and strategic partner. You will oversee analyses of medical and pharmacy claims to identify cost drivers and opportunities for affordability.

Working with clinical, finance, and operations leaders, you will build advanced analytics using Snowflake, PMPM metrics, forecasting, and AI-assisted insights, while mentoring analysts and advancing analytic standards.

Qualifications

• Bachelor’s or Master’s degree in a quantitative field.
• 7+ years of healthcare analytics experience with claims data.
• 5+ years of medical economics or related payer analytics experience.
• Proven ability to lead complex analyses from problem definition through executive recommendation.

Responsabilités

• Lead analyses of medical and pharmacy claims to identify cost trends.
• Partner with leaders to scope opportunities and measure impact.
• Develop advanced analytics using PMPM, utilization, risk adjustment.
• Design reusable analytic assets in Snowflake and automate workflows.
• Present findings to senior and executive leaders.

Connaissances

Advanced SQL

Snowflake

Python / R

Data visualization

Statistical modeling

Formation

Bachelor’s or Master’s degree

Outils

Snowflake

Power BI

Python/R tooling

Description du poste

Pay Range

$102,300.00 - $163,700.00

At BCBSRI, our greatest resource is our people.

We come from varying backgrounds, different cultures, and unique experiences. We are hard-working, caring, and creative individuals who collaborate, support one another, and grow together. Passion, empathy, and understanding are at the forefront of everything we do—not just for our members, but for our employees as well.

We recognize that to do your best work, you have to be your best self.

It’s why we offer flexible work arrangements that include remote and hybrid opportunities and paid time off. We provide tuition reimbursement and assist with student-loan repayment. We offer health, dental, and vision insurance as well as programs that support your mental health and well-being. We pay competitively, offer bonuses and investment plans, and are committed to growing and developing our employees.

Our culture is one of belonging.

We strive to be transparent and accountable. We believe in equipping our associates with the knowledge and resources they need to be successful. No matter where you’re at in the organization, you’re an integral part of our team and your input, thoughts, and ideas are valued.

Join Others Who Value a Workplace For All.

We appreciate and celebrate everything that makes us unique, from personal characteristics to past experiences. Our different perspectives strengthen us as an organization and help us better serve all Rhode Islanders.

We’re dedicated to serving Rhode Islanders.

Our focus extends beyond providing access to high-quality, affordable, and equitable care. To further improve the health and well-being of our fellow Rhode Islanders, we regularly roll up our sleeves and get to work (literally) in communities all across the state—building homes, working in food pantries, revitalizing community centers, and transforming outdoor spaces for children and adults. Because we believe it is our collective responsibility to uplift our fellow Rhode Islanders when and where we can, our associates receive additional paid time to volunteer.

Why This Job Matters

We are seeking an experienced Lead Medical Economics Analyst to serve as a senior individual contributor, technical leader, and strategic thought partner. Operating with significant autonomy, this role will lead complex analyses of medical claims and related healthcare data to identify cost drivers, quantify affordability opportunities, and translate findings into actionable strategies for business leaders.

We are looking for a candidate that has significant experience analyzing healthcare date along with a history of medical economics or total cost of care work. The qualified candidate will help modernize our analytics through advanced Snowflake capabilities and by using advanced analytical skills such as: automation, visualization, predictive modeling, and responsible use of artificial intelligence in day-to-day analytic workflows.

What You Will Do

• Medical Cost and TCOC Leadership: Lead analyses of medical and pharmacy claims to identify cost trends, utilization drivers, provider variation, site-of-service opportunities, and actionable medical cost savings.
• Initiative Valuation and Value Realization: Partner with clinical, provider, finance, and business leaders to scope opportunities, estimate financial impact, define success measures, and monitor results after implementation.
• Advanced Healthcare Analytics: Apply medical economics methodologies involving PMPM, utilization rates, unit cost, intensity, prevalence, risk adjustment, population segmentation, network performance, and value-based care.
• Leadership Reporting: Synthesize complex analyses into clear recommendations and present findings directly to senior and executive leaders.
• Snowflake Innovation: Design efficient, reusable analytic assets in Snowflake and expand the team’s use of advanced Snowflake functionality, including native analytics, data applications, automation, and visualization capabilities.
• AI-Enabled Analytics: Identify and implement practical, responsible uses of AI, generative AI, and large language models to accelerate data exploration, coding, documentation, quality review, and insight generation.
• Technical Leadership: Establish analytic best practices, improve code quality and reproducibility, mentor analysts, and raise the team’s overall technical capabilities.
• Tool and Process Modernization: Evaluate new tools and methods, automate recurring workflows, and build scalable frameworks that improve analytic speed, accuracy, and consistency.
• Cross-Functional Partnership: Lead complex projects involving stakeholders across medical management, pharmacy, value-based care, actuarial, finance, product, network, and operations.

What You Need To Succeed

• Bachelor’s or Master’s degree in mathematics, statistics, economics, data science, health informatics, actuarial science, computer science, or another quantitative field.
• At least 7 years of progressively responsible healthcare analytics experience, including substantial hands‑on work with healthcare claims and related payer data.
• At least 5 years of medical economics, Total Cost of Care, healthcare affordability, actuarial analytics, or closely related payer-focused analytic experience.
• Demonstrated experience independently leading complex analyses from problem definition through executive recommendation and post-implementation measurement.
• Experience identifying and quantifying medical cost opportunities within a health plan, payer, healthcare consulting organization, or payer-focused provider organization.
• Industry Knowledge: Deep understanding of medical and pharmacy claims, member enrollment, provider data, reimbursement, utilization, risk adjustment, and common health plan performance measures.
• Autonomy: Proven ability to manage multiple complex projects with limited oversight in a fast-paced environment, along with demonstrated ability to mentor analysts, influence stakeholders, and communicate complex findings to non‑technical and executive audiences.

Technical Skills

• Advanced SQL: Expert-level SQL for complex extraction, transformation, analytic modeling, performance optimization, data quality validation, and production-ready reusable logic.
• Snowflake: Advanced hands‑on experience working in Snowflake is strongly preferred. Experience should extend beyond query execution to capabilities such as Snowpark, Streamlit in Snowflake, Snowsight dashboards, Dynamic Tables, Tasks, Streams, stored procedures, data sharing, or performance optimization.
• Programming: Experience with Python, R or another analytical language is a plus.
• Visualization: Strong experience developing interactive dashboards and decision-support tools using Power BI, Streamlit in Snowflake, Snowsight, Tableau, or comparable platforms.
• Advanced Methods: Experience with statistical modeling, forecasting, predictive analytics, causal inference, machine learning, or other advanced methods used to evaluate cost, utilization, and program impact.

Location:

Role

BCBSRI is headquartered in downtown Providence, conveniently located near the train station and bus terminal. We actively support associate well‑being and work/life balance and offer the following schedules, based on role:

• In-office: onsite 5 days per week
• Hybrid: onsite 2-4 days per week
• Remote: onsite 0-1 days per week. Permitted to reside in the following states, pending approval from the Human Resources Department: Arizona, Connecticut, Florida, Georgia, Louisiana, Massachusetts, North Carolina, Oklahoma, Rhode Island, South Carolina, Texas, Virginia

Our culture of belonging at Blue Cross & Blue Shield of Rhode Island (BCBSRI) is at the core of all we do, and it strengthens our ability to meet the challenges of today’s healthcare industry. BCBSRI is an equal opportunity employer.