Highmark Health
Medical Economics Consultant
Providence ,
Rhode Island
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The Medical Economics Consultant is responsible for the development, coordination and management of medical economics analysis, models, health outcome studies and related forecasting and actual results analysis related to the portfolio of activities that are focused on operating margin improvements, primarily focused on medical spend. This work will leverage market-leading health plan medical economics processes, tools and reporting. This key new role will serve as the key link between the Finance/Consultative work in support of these initiatives and each business segment and functional area partners' work, with focus on 1) the analysis development to size the ideation, emerging results and financial impact 2) infrastructure and process development to link medical economic related analytics (trend reporting, medical cost, conditions, etc.) with business partner actions, including progress and impact. 3) dashboard building of financial information that will help track/evaluate initiative level activities.
ESSENTIAL RESPONSIBILITIES
Provide strategic/tactical insights into emerging medical cost trends. Develop executive ready presentations explaining analytical findings in a clear concise manner.
Proficiency to extract, summarize and analyze large datasets via SAS, SQL or other similar tools.
Provide business areas with opportunity assessments of their strategic medical cost programs. Coordinate savings opportunity projections and post implementation savings measurements. Develop improved business case and savings estimate capabilities to enable more accurate and deeper projections.
Leverage analytical experience and knowledge to drive independent medical cost analytics; develop areas of opportunity using a fact-based analysis, present medical cost analytics and insight into claim cost drivers to key business partners.
Strong communication skills (verbal and executive quality presentations) to present clear, concise presentations of the detailed analytics.
Work in a matrixed work environment. Partner with other departments in developing the full analytical story.
Other duties as assigned or requested.
EDUCATION
Required
Bachelor's Degree in Business, Health, Economics, Mathematics/Actuarial Sciences or other related area
Substitutions
None
Preferred
Master's Degree in Business, Health, Economics, Mathematics/Actuarial Sciences or other related area
Master's degree in STEM majors
EXPERIENCE
Required
5 years of Medical Economics, Healthcare Analytics, Informatics and/or Actuarial Services in the health care payer sector
Preferred
Comfort with ambiguity yet unstoppable drive to create order out of chaos
Passion for evolving quantitative methods; flexible in approaches such that you see opportunities for data where others might see constraints
LICENSES AND CERTIFICATIONS
Required
None
Preferred
None
SKILLS
Proven analytical ability to drive independent work and meet business timelines and outcomes.
Demonstrated ability to work with business partners in communicating outcomes, partnering on analytics, and developing new approaches to breaking down a strategic hypothesis.
Experience in the healthcare Industry, with solid knowledge of emerging trends and challenges
Languages (Other then English)
None
Travel Required
0% - 25%
PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS
Position Type
Office-Based
Teaches / trains others regularly
Occasionally
Travel regularly from the office to various work sites or from site-to-site
Rarely
Works primarily out-of-the office selling products/services (sales employees)
Never
Physical work site required
Yes
Lifting: up to 10 pounds
Constantly
Lifting: 10 to 25 pounds
Rarely
Lifting: 25 to 50 pounds
Never
Disclaimer:
The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job.
Compliance Requirement:
This position adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies.
As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company's Handbook of Privacy Policies and Practices and Information Security Policy. Furthermore, it is every employee's responsibility to comply with the company's Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements.
Pay Range Minimum:
$67,500.00
Pay Range Maximum:
$124,800.00
Base pay is determined by a variety of factors including a candidate's qualifications, experience, and expected contributions, as well as internal peer equity, market, and business considerations. The displayed salary range does not reflect any geographic differential Highmark may apply for certain locations based upon comparative markets.
Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities, and prohibit discrimination against all individuals based on their race, color, age, religion, sex, national origin, sexual orientation/gender identity or any other category protected by applicable federal, state or local law. Highmark Health and its affiliates take affirmative action to employ and advance in employment individuals without regard to race, color, age, religion, sex, national origin, sexual orientation/gender identity, protected veteran status or disability.
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