Medical Economics Analyst

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.

Job Summary:

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.