Position Summary: The Senior Medical Economics Analyst serves as a key contributor to the organization's financial and clinical performance by delivering advanced analytics on total cost of care, utilization, and value-based contract performance. This role is responsible for translating complex healthcare data, including claims, capitation, and provider performance metrics into actionable insights that support strategic decision-making across Finance, Operations, and Clinical Leadership.

This position combines financial acumen with healthcare analytics expertise to evaluate trends in medical cost, utilization, and reimbursement, identify drivers of performance, and recommend interventions that improve profitability, quality outcomes, and risk-based contract success. The role operates at the intersection of FP&A, actuarial analytics, and population health, supporting the organization's transition toward value-based care.

Essential Position Functions/Responsibilities:
Medical Economics & Cost of Care Analytics

• Analyze total cost of care (TCOC), including inpatient, outpatient, professional, and pharmacy spend, to identify key cost drivers and emerging trends
• Evaluate utilization metrics (e.g., admits/1,000, ER visits/1,000, SNF utilization, specialty referral patterns) and cost per unit to assess performance against benchmarks
• Perform detailed variance analysis across populations, products, and payer contracts to explain financial performance
• Identify drivers of unfavorable medical cost trends and recommend targeted interventions (e.g., utilization management, site-of-care optimization, payment integrity)

Value-Based Contracting & Risk Performance

• Analyze financial performance of capitation, shared savings, and risk-based contracts, including surplus/deficit, MLR, and settlement projections
• Develop models to assess the financial impact of payer rate changes, contract terms, and attribution shifts
• Partner with contracting and network teams to evaluate reimbursement structures and provider incentives
• Support risk adjustment analytics (RAF/HCC capture, coding accuracy) where applicable

Financial Modeling & Forecasting

• Develop and maintain robust financial and actuarial models to forecast medical expense trends and utilization patterns
• Support budgeting and forecasting processes for medical cost and risk-based revenue streams
• Perform scenario modeling to assess financial impact of strategic initiatives, population growth, or changes in care delivery
• Collaborate with FP&A leadership to integrate medical economics into enterprise financial planning

Cross-Functional Collaboration

• Partner with Clinical, Operations, Care Management, and Network teams to align financial insights with care delivery initiatives
• Partner with Information Technologies Business Intelligence Unit for data extraction and production processes for dashboards and scheduled reports
• Support population health strategies through data-driven identification of high-cost cohorts and intervention opportunities
• Translate analytical findings into actionable recommendations for non-financial stakeholders
• Serve as a subject matter resource for medical economics across the organization

Performance Monitoring & Continuous Improvement

• Develop and monitor key performance indicators (KPIs) related to cost, utilization, quality, and contract performance
• Track effectiveness of cost containment and performance improvement initiatives
• Identify opportunities to enhance data infrastructure, analytics capabilities, and reporting processes
• Stay current on healthcare reimbursement models, regulatory changes, and industry best practices

Qualification Requirements:
Skills, Knowledge, Abilities

• Strong knowledge of healthcare finance, medical economics, and managed care principles (capitation, risk adjustment, TCOC)
• Advanced analytical and financial modeling skills, including large dataset manipulation and statistical analysis
• Proficiency in SQL and advanced Excel (modeling, pivot tables, VBA); experience with BI tools (Tableau, Power BI)
• Ability to synthesize complex data into clear, actionable insights for executive audiences
• Understanding of claims data structures, provider reimbursement methodologies, and utilization metrics
• Strong problem-solving skills with attention to detail and data accuracy
• Excellent communication and presentation skills, with the ability to influence cross-functional stakeholders

Training/Education:

• Bachelor's degree in Finance, Accounting, Economics, Actuarial Science, Public Health, or related field required
• Master's degree (MBA, MPH, or related) or relevant certifications (e.g., CFA, ASA progress) preferred

Experience:

• Minimum of 5-7 years of experience in healthcare analytics, medical economics, FP&A, or managed care finance
• Experience in an IPA, MSO, health plan, or value-based care environment strongly preferred
• Demonstrated experience working with claims data, cost of care analysis, and financial forecasting
• Experience supporting risk-based or capitated contract performance preferred

Base Compensation Range: $125,000 - $140,000

Job Disclaimer:
The above job description outlines the general scope and responsibilities of the position. It is not intended to be an exhaustive list of duties, skills, or qualifications required. Responsibilities may evolve based on business needs.

Department: Finance
This is a non-management position
This is a full time position