Senior Medical Economics Consultant

Company :

Highmark Inc.

Job Description :

JOB SUMMARY

This job is responsible for using medical cost analytics to provide fact based strategic insights into emerging medical cost trends. Using large sets of data, the incumbent will create the story of medical cost trends in a way that is clear, concise and easily understandable. Will have a high-level of proven detailed analytical experience with strong communication and influencing skills. More specifically, will develop segment specific medical economic analytics which will be presented to senior business leaders and clinical business partners. The incumbent will engage with matrix partners to develop the potential medical cost savings value of business solutions through data driven analytics, including but not limited to: 1) developing the value of the programs, 2) tracking the outcomes of the programs, and 3) providing strategic insight into areas of focus/opportunities. The incumbent will be able to work directly with the business partners, understand the business problem to be analyzed and develop the analysis independently (with little to no supervision). Will have expert level data mining and storytelling abilities and will serve as a mentor to analysts and consultants as well as to other analytical teams.

ESSENTIAL RESPONSIBILITIES

Provide strategic/tactical insights into emerging medical cost trends. Develop executive ready presentations explaining medical cost analytical findings in a clear concise manner. Partner with Actuarial/Finance teams to develop full medical cost story.

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 medical economics 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 senior business leaders and matrix partners.

Strong communication skills (verbal and executive quality presentations) to present clear, concise presentations of the detailed analytics.

Work independently with the business partners in understanding the business problem to be analyzed, developing the analysis and presenting outcomes/potential scenarios.

Serve as a mentor to newer team members, business partners and additional resources (as needed).

Lead in a matrixed work environment: (a) Influence other departments where you do not have direct authority, (b) Help drive a culture change from “reporting the past” to “creating the solutions for future, (c) Be persistent in following up with senior management and staff from numerous departments, (d) Collaborate with P&L owners and functional leaders.

Other duties as assigned or requested.

EDUCATION

Required

Bachelors Degree in Business, Health, Economics, Mathematics/Actuarial Sciences or other related area

Substitutions

None

Preferred

Masters Degree in Business, Health, Economics, Mathematics/Actuarial Sciences or other related area

LICENSE/CERTIFICATION

Required

None

Preferred

None

EXPERIENCE

Required

7 years in Medical Economics, Healthcare Analytics, Informatics and/or Actuarial Services in the health care payer sector

To Include:

5 years in Medical Economics/Healthcare Analytics

3 years of Statistical/Quantitative Modeling

Preferred

None

SKILLS

Analytical Leadership to drive independent analyses, partner with key business partners and mentor others.

Demonstrated ability to drive independent work and meet business timelines and outcomes.

Proven ability to work independently, developing analytics from a high-level hypothesis to detailed analytical facts.

Expert skills in SAS / SQL, R, Tableau, Excel, etc.

Demonstrated ability to liaison directly with business partners/leaders 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

Language Requirement (other than English)

None

Travel Requirement

0% – 25%

PHYSICAL, MENTAL DEMANDS, AND WORKING CONDITIONS

Position Type

Office-Based

Teaches / trains others regularly

Frequently

Travel regularly from the office to various work sites or from site-to-site

Occasionally

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 job 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.

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.

EEO is The Law

Equal Opportunity Employer Minorities/Women/Protected Veterans/Disabled/Sexual Orientation/Gender Identity ( https://www.eeoc.gov/sites/default/files/migratedfiles/employers/posterscreenreaderoptimized.pdf )

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For accommodation requests, please contact HR Services Online at HRServices@highmarkhealth.org

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Req ID: J252305