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Job description
Summary:
Work with other team leaders to improve operational efficiencies and resource allocations for improved performance of the EmblemHealth plans.
Responsible for running queries and providing required analysis to understand related drivers (such as medical cost and utilization), and to provide insightful commentary and sensitivity modeling analysis.
Develop data-driven analysis for decision making on how EmblemHealth purchases, manages, and influences the cost of care for current and prospective members.
Extract, analyze, and interpret data for more complex insights related to cost drivers and to manage the escalation of issues that impact costs, and impact of health cost containment initiatives.
Provide consultative subject matter expertise to aligned business areas to demonstrate analytics rooted in data.
Responsibilities:
Ensure data integrity is maintained throughout the reporting lifecycle.
Implement reporting and reconciliation workflows and document processes.
Responsible for experience studies and medical trend studies.
Perform research and collection of data, including data mining and reporting, which is provided to various customers inside and outside the department.
Implement automation of manual reporting and analysis of business implications and trends.
Lead efforts to continually improve data capabilities and quality of department analysis and reporting.
Create, develop, and design analytics and reporting to measure or estimate financial impact of health plan business problems and potential or actual solutions, addressing escalated issues with subject matter expertise.
Lead and manage several corporate and health cost containment initiatives, supporting staffing to deliver results across all functions within Medical Economics.
Develop research and analytic processes to review financial data to draw conclusions for senior leadership.
Represent the department to internal and external partners with presentation of data and results for use in administering specific programs and processes related to medical expense and utilization.
Present analytical findings to internal business partners, leading discussions and providing delivery of further analysis.
Analyze business problems related to financial experience of the health plan, particularly related to how care is purchased, managed, or other factors influencing cost of care.
Perform additional duties as assigned.
Requirements:
BA/BS in Mathematics, Statistics, Economics, Healthcare or related discipline required; Master's preferred.
4 - 6+ years' experience working in a healthcare setting (within a provider health system or health insurance company) required
Ability to query, summarize, and manipulate data using SQL or SAS required
High level of proficiency with MS Office (Word, Excel, PowerPoint, Outlook, etc.), with an emphasis on Excel required
Experience working in a healthcare setting (within a provider health system or health insurance company) preferred
Experience working with healthcare data including but not limited to claims, testing results and pharmacy data required
Strong communication skills (verbal, written, presentation, interpersonal) required
Experience preparing/presenting dashboards and data using a data visualization tool such as Tableau preferred
Additional Information
Requisition ID: 2603O
Hiring Range: $68,040-$118,800
Who can apply
Review the original listing for work authorization, qualifications and employer requirements.