Lead Medical Economics Anayst
We are seeking a highly analytical and detail-oriented Senior Medical Economics Analyst. This role is critical in driving data-informed decisions through advanced analysis of healthcare utilization, cost trends, and performance metrics, with a strong emphasis on Medicare Advantage and SQL-based data manipulation.
The ideal candidate will have deep experience working with large healthcare datasets, a strong understanding of Medicare programs, and the ability to translate complex data into actionable insights for clinical, operational, and financial stakeholders.
Key Responsibilities:
- Analyze medical and pharmacy claims data to identify cost drivers, utilization trends, and opportunities for cost containment.
- Develop and maintain complex SQL queries to extract, transform, and analyze large datasets from multiple sources.
- Conduct financial impact analyses of clinical programs, provider performance, and policy changes, particularly within Medicare Advantage populations.
- Collaborate with actuarial, clinical, and finance teams to support forecasting, budgeting, and strategic planning.
- Create dashboards, reports, and visualizations to communicate findings to both technical and non-technical audiences.
- Monitor and evaluate the effectiveness of care management and quality improvement initiatives.
- Ensure data integrity and compliance with CMS regulations and internal data governance standards.
Qualifications:
Required:
- Bachelor's degree in Economics, Statistics, Public Health, Health Informatics, or a related field (Master's preferred).
- 5+ years of experience in healthcare analytics, with at least 3 years focused on Medicare Advantage.
- Advanced proficiency in SQL (e.g., joins, subqueries, CTEs, window functions).
- Strong understanding of healthcare claims data (medical, pharmacy, eligibility).
- Experience with CMS data sets, risk adjustment, and HEDIS/Stars metrics.
- Proficiency in Excel and data visualization tools (e.g., Tableau, Power BI)
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