Position SummaryThe Medical Economics Analyst is responsible for analyzing healthcare utilization, cost, and financial performance to identify actionable opportunities to improve affordability and support sustainable medical cost management. This role works across claims, membership, utilization, and provider data to evaluate performance, quantify the impact of clinical and network strategies, and inform decision-making for internal stakeholders, payers, and strategic partners.
Key Responsibilities- Identify, quantify, and model opportunities to reduce medical costs across markets, products, and lines of business
- Evaluate the effectiveness and financial impact of medical cost containment and clinical programs
- Own the full analytic lifecycle, including data sourcing, validation, modeling, interpretation, and recommendations
- Analyze drivers of specialty spend across services such as vision, dermatology, therapy, and other high-impact categories
- Monitor PMPM trends and utilization performance across specialties and all lines of business
- Evaluate healthcare utilization to identify patterns, variation, and outliers and translate findings into actionable insights
- Develop scalable analytical tools and dashboards to enable efficient comparison of performance across markets, products, and populations
- Assess the efficiency and effectiveness of clinical programs, interventions, and operational workflows
- Analyze site-of-care optimization opportunities, network leakage, and utilization patterns across provider networks
- Support intake, prioritization, and coordinated execution of ad-hoc and strategic analytics requests across the organization
- Communicate findings clearly to technical and non-technical audiences, including executive-level stakeholders
- Perform other duties as needed.
Required Qualifications- Bachelor's degree (or equivalent experience) in Public Health, Data Analytics, Health Informatics, Business, or a related field
- 3+ years of experience with advanced SQL and Excel (Power Query / Power Pivot), Power BI in healthcare analytics environment
- Demonstrated ability to analyze and interpret large, complex healthcare datasets
- Understanding of value-based care or risk-based arrangements
- Strong analytical mindset with intellectual curiosity and a structured approach to problem-solving
- High attention to detail, strong organizational skills, and the ability to manage multiple priorities in a fast-paced environment
- Exceptional written and verbal communication skills, with a bias toward clarity, conciseness, and actionable insights
Preferred Qualifications- Experience with data science tools or programming languages such as Python or R
- Experience incorporating automation or AI-enabled tools into analytics workflows
