Senior Medical Economics Analyst

We are looking for a highly analytical and detail-oriented Senior Medical Economics Analyst to support value-based care and managed care strategies. This role will be instrumental in evaluating healthcare utilization, cost trends, and provider performance to drive improvements in quality, efficiency, and financial outcomes.

Key Responsibilities:

Value-Based Care (VBC) Analytics:

• Analyze performance of VBC contracts including shared savings, bundled payments, and risk-based arrangements.
• Develop financial models to assess the impact of VBC initiatives on cost, quality, and utilization.
• Collaborate with clinical, actuarial, and network teams to identify opportunities for improvement and cost containment.
• Monitor key metrics such as PMPM (per member per month) costs, risk adjustment, and quality scores.

Managed Care Support:

• Evaluate managed care performance using claims, eligibility, and encounter data.
• Support contract negotiations with data-driven insights on utilization trends, cost drivers, and provider efficiency.
• Assist in the development of provider scorecards and dashboards to track performance against benchmarks.
• Ensure compliance with payer requirements and regulatory standards.

Data Analysis & Reporting:

• Design and maintain reports and dashboards to communicate findings to internal stakeholders.
• Use statistical and predictive modeling techniques to forecast trends and identify anomalies.
• Translate complex data into actionable insights for both technical and non-technical audiences.

Qualifications:

• Bachelor's degree in Health Economics, Statistics, Public Health, Actuarial Science, or related field (Master's preferred).
• 4+ years of experience in healthcare analytics, medical economics, or managed care.
• Strong understanding of VBC models, managed care principles, and healthcare reimbursement.
• Proficiency in SQL, Excel, and at least one statistical tool (e.g., SAS, R, Python).
• Experience working with large healthcare datasets (claims, EMR, eligibility, etc.).

Preferred Skills:

• Familiarity with HEDIS, risk adjustment methodologies, and CMS/Medicaid programs.
• Experience with data visualization tools (e.g., Tableau, Power BI).
• Strong communication and presentation skills.