Senior Healthcare Analytics Analyst - Health Alliance Plan

GENERAL SUMMARY:

Support new healthcare data analytic capabilities for premium, enrollment, claims and non-claim expenses. Performance evaluation in terms of quality, timeliness, insights and clarity of trend opportunities and variance magnitude.

Evaluates healthcare data and create segmentation reports that include trend analysis (cost, price, and utilization); comparisons provider groups and hospital systems; Milliman benchmarking; and risk and quality measures. Data assessed is based on claims, member demographics, evidence-based measures, Global RVUs, MARA risk scores, ACA markets, provider regions and product segments. Create dashboards, report packages and visualizations for HAP leadership to ensure that convey performance patterns and areas for improvement. Monitor trends to proactively identify issues. Internal data cleansing, data reconciliation analysis and gathering business requirements as needed. Manage multiple projects and timelines effectively and communicate risks and issues to the director regularly.

 PRINCIPLE DUTIES AND RESPONSIBILITIES:

• Conducts analysis associated with medical cost saving initiatives, leading indicators, rate model and pricing related data, contract efficiency with providers, and adherence to quality standards. Participates and/or leads cross-functional corporate business teams and meetings in the development of medical economics programs, targets, and results as they relate to specific corporate strategies and programs.
• Develops best in class and forward-thinking methods/criteria for measuring and summarizing healthcare performance data. Integrates information from multiple sources, discerns implications for future analysis and identifies opportunities for enhancing integrity of medical data.
• Prepares historical analyses (e.g., PMPM, Utilization per one thousand, and Price per resource) for targeted medical cost categories, geographies, and segments. Conducts analysis of membership mix and its resulting impact on utilization models. Validates findings against Milliman benchmarks. Utilizes baseline metrics and trends to establish medical cost savings forecast models.
• Supports the development and implementation of strategic medical management and/or network management initiatives, product offerings or other strategic business programs through extraction, analysis and summarization of appropriate data sets and benchmarks.
• Partners with IT, Data & Analytic Strategy, Finance, Actuarial, Sales, Product Management, Market Intelligence, Claim Services, Pharmacy Services, Provider Network Management, Utilization Management, and Population Health to champion, develop, and monitor sound cost valuation methodologies for medical and/or network management programs and initiatives.
• Communicates and describes the findings to business questions and objectives pertaining to medical costs, contracting performance, and/or clinical/network performance to key leadership and/or stakeholders.
• Prepares and delivers well-organized and compelling presentations to reflect key findings, analytic methods to determine such findings, future analysis, and implications; and the identifications of opportunities to drive business improvements.
• Prepares reports and presentation for running the business meetings quarterly.
• Performs other related duties as assigned.