Medical Economics Analyst

Horizon BCBSNJ employees must live in New Jersey, New York, Pennsylvania, Connecticut or Delaware

Job Summary:

• Works within Health Care Management to provide analysis to inform the strategic focus for the identification and implementation of network and medical cost management strategies.

• Develops and monitors a series of metrics and reports related to medical cost performance.

• Works closely with the Value Based Program team to understand the operations of the program including attributed membership and shared savings calculations and supports the integrity of the Program through objective review and validation.

• Develops and leads key Healthcare Management Reporting on a monthly basis aimed at the presenting and understanding of specific HCM P&L performance including, but not limited to (i) Variance Analysis/Commentary Actual vs Budget/Plan and Prior Year (ii) Revenue detail and components (iii) Medical Cost detail and components (iv) Product Mix (v) Market Segments.

• Leads the coordination and consolidation of the HCM Monthly Operating Review (MOR).

• Gathers and utilizes analytics from multidisciplinary teams to develop and evaluate the performance of existing medical cost activities across Health Care Management and consults with business leaders on observations and recommendations.

• Provide support to the Value Based Program analytics initiatives through data mining and extraction, report and presentation design, financial modeling, identification of medical cost trend drivers, and consolidation of medical action plans.

• Implement analytic tools and techniques to identify cost drivers and ways to improve medical cost performance.

• Evaluates the feasibility of strategic initiatives and new business opportunities. This includes providing support in developing financial program scenarios for current and potential Value Based Program partners related to program evolution or customization. Actively participates within the development of the future state of Value Based Programs.

• Works in multidisciplinary teams to identify, quantify return on investment, and track medical cost reduction initiatives. This includes within HCM and coordinating with finance and actuarial team to connect medical cost activities to the enterprise financial process.

Disclaimer:
This job summary has been designed to indicate the general nature and level of work performed by colleagues within this classification. It is not designed to contain or be interpreted as a comprehensive inventory of all duties, responsibilities, and qualifications required of colleagues assigned to this job.

• High School Diploma/GED required.

• Bachelor degree in accounting or finance preferred or relevant experience in lieu of degree.

• Requires a minimum of 3-5 years of experience in health care/managed care with direct responsibility within a Financial Planning & Analysis (FP&A) and/or Medical Cost Management & Analysis discipline.

• Requires a progressive understanding of managed care business processes, data, systems, and applications for claims payment, enrollment, benefit design, product pricing, network and provider contracting, and utilization management.

• Experience working closely with business partners such as Analytics, Actuaries and/or FP&A in order to develop solid skillsets with the following disciplines: medical cost analysis, market segment premium development, monthly financial reporting and variance analysis, annual business plan/budget development and presentations to management.

• Requires solid understanding of P&L management principals, actual versus budget variance analysis, and general knowledge of budgeting and planning principals.

• Requires general knowledge of the components underneath medical cost and utilization trends, as well as how to appropriately presents year-over-year comparisons to specifically identify variances/changes to budget and prior year.

• Requires knowledge of Commercial and Medicare market sectors and products.

• Requires knowledge of healthcare/managed care industry operations and products and how they relate to key metrics within financial statements.

• Requires proven quantitative and financial analysis skills.

• Requires the ability to express thoughts clearly and concisely, both verbally and in writing.

• Requires a demonstrated aptitude for analytical thinking and the ability to report findings in an accurate manner.

• Requires the ability to research and resolve problems through interaction with company-wide personnel.

• Requires process mapping capabilities in order to develop new methodologies to achieve a desired end result.

• Requires the ability to work independently with minimal direct supervision and exercise sound business judgment.

• Requires direct knowledge, or the ability to learn quickly Horizons Accounting and Financial Planning & Analysis (FP&A) platforms (ex. Lawson General Ledger system, Hyperion Planning).

• Requires advance knowledge of Excel.

• Requires experience with Word and PowerPoint.

• Requires technical skills with database concepts, data analysis development, data warehousing, and data extraction tools (ex. SQL).

Salary Range:

This compensation range is specific to the job level and takes into account the wide range of factors that are considered in making compensation decisions, including but not limited to: education, experience, licensure, certifications, geographic location, and internal equity. This range has been created in good faith based on information known to Horizon at the time of posting. Compensation decisions are dependent on the circumstances of each case. Horizon also provides a comprehensive compensation and benefits package which includes:

• Comprehensive health benefits (Medical/Dental/Vision)

• Retirement Plans

• Generous PTO

• Incentive Plans

• Wellness Programs

• Paid Volunteer Time Off

• Tuition Reimbursement

Horizon Blue Cross Blue Shield of New Jersey is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or status as an individual with a disability and any other protected class as required by federal, state or local law. Horizon will consider reasonable accommodation requests as part of the recruiting and hiring process.