Remote Medical Economics Analyst

HOPCo; Phoenix (AZ); Remote; USD 90.000 - 130.000; Vollzeit

Zusammenfassung

The CORE Institute in Phoenix, AZ is seeking a data and analytics professional to lead complex medical economic projects, analyze healthcare claims, and develop models to answer business questions for internal and external clients. Responsibilities include applying statistical methods, presenting findings to management, ensuring data integrity, and collaborating across teams to meet operational targets.

Bachelor’s degree preferred; 3+ years healthcare experience; strong SQL, Power BI, and Excel

Qualifikationen

• 3+ years in health insurance, value-based care, or healthcare administration
• 2+ years analyzing healthcare claims and eligibility data
• Experience with capitated and fee-for-service provider contracts across Medicare, Medicare Advantage, Commercial, and Medicaid
• Proficiency with SQL and healthcare data analytics
• Experience with reporting tools such as Power BI

Aufgaben

• Lead or participate in medical economic projects.
• Apply statistical analysis to develop models and reporting tools.
• Provide medical cost trend analytics and forecast contract terms.
• Present results to management across VBC teams.
• Ensure data integrity and on-time deliverables.
• Collaborate cross-functionally to achieve targets.

Kenntnisse

SQL

Healthcare analytics

Power BI

Excel

Data modeling

Statistical analysis

Project management

Ausbildung

Bachelor's degree preferred

Tools

SQL Server

DB2

SAS

Power BI

Excel

Jobbeschreibung

ESSENTIAL FUNCTIONS

• 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.
• Present 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.

EDUCATION

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

EXPERIENCE

• Healthcare Industry Experience: 3+ years in health insurance, value-based care, or healthcare administration
• Data & Analytical Expertise:
  • 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
• Contract & Product Knowledge:
  • 2+ years of experience analyzing capitated and fee-for-service provider contracts across:
  • Medicare, Medicare Advantage, Commercial, and Medicaid plans

Technical Skills

• 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

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.
• This description is intended to provide only basic guidelines for meeting job requirements. Responsibilities, knowledge, skills, abilities, and working conditions may change as needs evolve.

Equal Opportunity Employer

This employer is required to notify all applicants of their rights pursuant to federal employment laws.For further information, please review the Know Your Rights notice from the Department of Labor.