Site: Mass General Brigham Health Plan Holding Company, Inc.
Job SummaryMass General Brigham Health Plan is an exciting place to be within the healthcare industry. As a member of Mass General Brigham, we are on the forefront of transformation with one of the world's leading integrated healthcare systems. Together, we provide our members-across Commercial, Medicare Advantage, and Medicare-Medicaid Dual Eligible (Duals) products-with innovative, high-quality, and affordable care.
Our work centers on creating an exceptional member experience supported by rigorous medical economics and data-driven decision-making. Employees collaborate with accomplished healthcare professionals in a consciously inclusive environment where diversity is celebrated.
The Senior Healthcare Analyst provides value-added analytic support in the development and monitoring of standard and ad hoc medical cost and utilization reporting for the health plan's Medicare Advantage and Dual Eligible populations. As part of this work, the analyst independently designs and performs complex analyses with enterprise-level impact.
Primary Responsibilities:
Cost and Utilization:
-Participates in the development and ongoing enhancement of medical cost and utilization analysis and reporting across Medicare Advantage and Dual Eligible lines of business.
-Analyzes and interprets utilization and medical expense data; identifies key drivers including risk mix, Stars-related utilization, and site of care; performs drill-down analyses; and presents findings to leadership.
-Works with clinical, finance, and operations partners to ensure accurate capture, interpretation, analysis, and reporting of claims, encounters, and authorization data in alignment with CMS requirements.
-Supports enterprise trend management activities by monitoring emerging utilization and unit cost trends, identifying variance drivers against expectations, and partnering with clinical, finance, and operations leaders to inform mitigation strategies and performance management.
-Partners with clinical, finance, operations, and other teams to support the delivery of regulatory reporting, provider reporting, and related analytic requests, including Medicare Advantage and Dual Eligible reporting requirements; ensure analyses are accurate, auditable, and aligned with CMS, internal governance, and external stakeholder needs.
Clinical Program Evaluation:
-Drives the development of program metrics and outcomes during the design of new medical management, care management, and population health initiatives, particularly for Medicare Advantage and Dual Eligible populations.
-Designs and conducts analyses evaluating financial, utilization, quality, and clinical effectiveness of programs; interprets results and presents actionable insights to senior leaders.
-Collaborates with external vendors and delegated entities in analyzing outcomes of vended Medicare Advantage and Duals programs.
-Quantifies the impact of clinical and Stars-driven initiatives on medical expense trends and partners with finance and budgeting teams to incorporate results into forecasts and CMS bid support.
Overall:
-Designs and executes complex queries, executive-ready analysis, and reporting in support of ad hoc analytical and regulatory requests.
-Designs, develops, and maintains agile ad hoc and repeatable reporting solutions using Power BI, enabling business partners to independently explore data, monitor performance, and conduct meaningful cost, utilization, and trend analyses with confidence.
-Ensures validity, accuracy, and reproducibility of all analyses and reported information.
-Works collaboratively with IT and data teams to enhance automation, establish data standards, and improve analytic infrastructure.
-Anticipates internal customer needs, builds trusted relationships, and proactively brings forward strategic Medicare Advantage and Duals insights.
QualificationsEducationWork Experience- At least 3-5 years of experience in membership, claims, and risk data analytics experience required
- At least 2-3 years of experience in D-SNP or Medicare Advantage
- Medicare STARS experience highly preferred
Knowledge, Skills, and Abilities- Strong written and oral communication skills
- Strong attention to detail and organization
- Good analytical and mathematical skills
- Supervisor Excel skills required
- Strong ability to work independently and manage one's time
- Ability to analyze, consolidate, and interpret accounting data
Additional Job Details (if applicable)Working Conditions - This is a remote role that can be done from most US states
- Employees must use a stable, secure, and compliant workstation in a quiet environment. Teams video is required and must be accessed using MGB-provided equipment.
Remote TypeRemote
Work Location399 Revolution Drive
Scheduled Weekly Hours40
Employee TypeRegular
Work ShiftDay (United States of America)
Pay Range$79,560.00 - $115,720.80/Annual
Grade7
At Mass General Brigham, we believe in recognizing and rewarding the unique value each team member brings to our organization. Our approach to determining base pay is comprehensive, and any offer extended will take into account your skills, relevant experience if applicable, education, certifications and other essential factors. The base pay information provided offers an estimate based on the minimum job qualifications; however, it does not encompass all elements contributing to your total compensation package. In addition to competitive base pay, we offer comprehensive benefits, career advancement opportunities, differentials, premiums and bonuses as applicable and recognition programs designed to celebrate your contributions and support your professional growth. We invite you to apply, and our Talent Acquisition team will provide an overview of your potential compensation and benefits package.
