Description
Founded in 1934, Medical Mutual is the oldest and one of the largest health insurance companies based in Ohio. We provide peace of mind to more than 1.2 million members through our high-quality health, life, disability, dental, vision and indemnity plans. We offer fully insured and self-funded group coverage, including stop loss, as well as Medicare Advantage, Medicare Supplement, and individual plans.
Lead Medical Economics Analyst
Job Summary:
The Lead Medical Economics Analyst role is responsible for developing complex analytics and scenario modeling that will guide strategic thinking, drive collaboration and provide actionable cost-savings data analysis or support clinical intervention program development and evaluations. This includes ensuring data results from multiple data sources are accurate, insightful and actionable. Works with leadership to define annual strategic priorities and articulate cross-functional work plans. Ensures reporting outcomes are developed, measured, evaluated, and published in a timely manner. Manages multiple projects with competing deadlines and works with team and leadership to prioritize deliverables. Provides coaching and mentoring to junior and senior Medical Economic Analysts. This also includes facilitating knowledge transfer and advance staff development.
Responsibilities:
- Works methodically with leadership to define annual objectives and priorities.
- Lead and/or conduct investigations and analyses to design methods to evaluate program efficiency in terms of financial investment or clinical effectiveness.
- Developing standardized practices to track progress of clinical programs over time to further understand the overall impacts of the program in terms of cost, use and resource management.
- Works with junior and senior analysts to understand and develop analytics, data visualizations and workflow processes to design new processes or improve on existing ones. Coach and mentor team members including knowledge transfer and innovative staff development.
- Manages multiple projects and scope with competing deadlines. Collaborates with department leadership and business partners to prioritize deliverables.
- Lead cross-functional teams to establish instrumentation and reporting standards.
- Interpret and investigate trends, patterns, and relationships between data sources.
- Performs other duties as assigned.
Qualifications:
Education and Experience:
- Bachelor Degree in Business Administration, Healthcare Administration, Finance, or related degree. Master's degree preferred
- 5-7 years of experience in data analysis, data mining and programming best practices.
- Healthcare background preferred.
Professional Certification(s):
- SAS Certification preferred
Technical Skills and Knowledge:
- Understanding and working with a variety of systems (e.g., MS Office, Tableau, SAS, SQL Server and/or other platforms and technologies). Proficient with Microsoft Office software and other data analytic tools.
- Strong PROC SQL writing skills with the ability to digest and document business workflow and data flow processes.
- Working with minimal direction, initiate projects, and demonstrate significant flexibility to coordinate complex activities that are often subject to rapid or extensive changes or revisions.
- Ability to lead conceptualization, development and execution of new data sources or enhancements to existing data sources.
Preferred Qualifications:
- Advanced experience and expertise in data extraction and analytical programming languages (SAS, SQL, Databricks, Python, R), and data visualization tools (PowerBI, Tableau), and the ability to perform queries and retrieve data from multiple tables and/or sources.
- Significant track record of success with analyzing clinical, claims, pharmacy, program and other administrative data.
- Advanced knowledge of health insurance products and industry, including trends and drivers of population health status, utilization, costs and quality, and application of that knowledge to drive strategic decision making.
Sr. Medical Economics Analyst
Assist the Director, Medical Economics by conducting analyses and developing actionable clinical initiatives around key clinical performance opportunities through qualitative and quantitative analyses of utilization and health care costs data. The role of Sr. Medical Economics Analyst serves as a leader for the Medical Economic team and provides experienced, focused analyses on medical cost and utilization drivers, care delivery and coordination opportunities, provider network profiling activities, and value-based care.
Responsibilities:
- Create innovative analytics solutions that identify actionable and impactful clinical initiatives to reduce medical expense and improve quality
- Lead the team in performing analyses on population health utilization, cost, and management analytics as directed.
- Gather data from multiple sources and develop necessary analytic data result sets to enable accurate and robust quantitative analyses.
- Forecast costs, utilization trends and create financial models using claims and other healthcare data.
- Provide analytic support for provider profiling and comparative analysis in efficiency and effectiveness performance metrics.
- Analyze benchmarking data, reports, processes and measurements for key managed care indicators and compare to MMO actual results.
- Leverages MMO's business intelligence tools that support analysis and reporting of member population health, provider profiling activities, and line of business product reporting.
- Conduct ad hoc analyses to support data driven insights on prioritized clinical initiatives
- Work cooperatively and collaboratively with staff at all levels across the organization
- Performs other duties as assigned.
Qualifications:
Education and Experience:
- 4 to 6 years of healthcare financial and analytical experience in a managed care setting.
- Strong analytical and problem solving skills
- BA/BS - Bachelors Degree in a related field, required
- Proficiency in Microsoft Office; SQL; SAS
Technical Skills and Knowledge:
- Working knowledge of SAS and/or SQL; knowledge of writing queries and analytical reports required
- Demonstrated ability to pull large data sets and perform data manipulations/analysis
- Familiarity with industry related BI population health tools
Preferred Qualifications:
- Advanced experience and expertise in data extraction and analytical programming languages (SAS, SQL, Databricks, Python, R), and data visualization tools (PowerBI, Tableau), and the ability to perform queries and retrieve data from multiple tables and/or sources.
- Significant track record of success with analyzing clinical, claims, pharmacy, program and other administrative data.
- Advanced knowledge of health insurance products and industry, including trends and drivers of population health status, utilization, costs and quality, and application of that knowledge to drive strategic decision making.
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