A leading Health Plan is looking for a Medical Economics Analyst to join their team. Your role is instrumental in analyzing Medicare Advantage medical claims data provided by health plan partners. You will work closely with membership files from health plans to ensure proper payments are received for the Medicare Advantage risk population. Your expertise in healthcare economics and data analysis will be pivotal in providing analytics to the organization, shedding light on Medicare Advantage population cost trends, and supporting strategic decision-making.
Responsibilities
- Medicare Advantage Claims Data Analysis
- Utilize advanced statistical techniques to analyze and interpret Medicare Advantage medical claims data received from health plan partners.
- Identify patterns, outliers, and critical insights to inform decision-making.
- Work with membership files from health plans to validate and ensure accurate payments for the Medicare Advantage risk population.
- Provide comprehensive analytics to the organization regarding Medicare Advantage population cost trends.
- Prepare and present detailed reports and dashboards specific to Medicare Advantage, communicating key findings and recommendations.
Qualifications:
- Bachelor's or Master's degree in Economics, Finance, Healthcare Management, or a related field.
- Experience working on Medicare Advantage
- Knowledge of Medicare Advantage economics, reimbursement methodologies, and healthcare policy.
- Excellent communication and interpersonal skills.
Preferred Skills:
- Experience with SQL and SAS.
- In-depth knowledge of Medicare Advantage regulations, compliance requirements, and risk adjustment methodologies.
- Previous experience in a similar role within the health insurance or managed care industry, with a focus on Medicare Advantage.
