Senior Medical Economics Analyst - Health Alliance Plan
🔍 Troy, Michigan
GENERAL SUMMARY:
The Senior Medical Economic Analyst plays a critical role in analyzing healthcare utilization and medical cost trends to support data driven decision-making within the health plan. Responsibilities include monitoring health plan performance, identifying drivers of medical cost trends, and conducting complex analyses to uncover financial improvement opportunities. Utilizes data from multiple sources to identify key risks and emerging opportunities.
PRINCIPLE DUTIES AND RESPONSIBILITIES:
- Extract, manipulate, and synthesize large healthcare datasets using analytical tools to uncover risks, trends, and opportunities that drive strategic decision-making.
- Analyze medical cost trends and identify primary drivers affecting health plan performance.
- Perform analyses to assess the underlying factors driving medical costs—including utilization, pricing, and service mix—and develop actionable strategies to improve financial outcomes and operational efficiencies.
- Conduct pro forma sensitivity analyses to estimate the expected financial impact of proposed medical cost improvement initiatives.
- Utilize statistical models and predictive analytics to evaluate and forecast medical cost trends, assess risk factors, apply risk matching techniques, identify high-risk populations, and anticipate potential financial challenges.
- Optimize data processes by automating data extraction, analysis, and reporting workflows, integrating dashboard/visualization tools to enhance efficiency and improve accessibility of key insights for leadership.
- Collaborate with clinical and cross-functional teams to enhance data analyses with supplemental insights and design studies that quantify the impact of medical interventions.
- Evaluate vendor and partnership performance, focusing on value and return on investment (ROI), and communicate findings to key leadership and stakeholders.
- Communicate and present findings to key leadership and stakeholders, addressing business questions and objectives through various reporting methods, presentations, and strategic discussions.
- Take proactive initiative and show curiosity in exploring new opportunities to enhance cost-saving strategies and improve overall financial performance.
- Perform other related duties as assigned.
EDUCATION/EXPERIENCE REQUIRED:
Must have an undergraduate (BS) degree in Statistics, Mathematics, Economics, Public Health, and Finance or another related field.
Minimum of five (5) years of progressive analytical experience in U.S. health insurance, managed care, or healthcare finance and analytics.
- Minimum of one (1) year of experience in leading staff in projects or supervisory/management position preferred.
- Proficiency in Microsoft Excel (including formulas, PivotTables, PowerQuery, PowerPivot).
- Proficiency in SQL for retrieving, manipulating, and analyzing data from various sources.
- Experience with data visualization and management, including building dashboards in Excel, Power BI, Tableau.
- Applying advanced analytics using SAS, R, or Python preferred.
- Proficiency in healthcare and medical economics data, with a strong understanding of healthcare industry coding systems, including ICD-10, CPT/HCPCS, and DRGs.
- Experience in quantifying, measuring, and analyzing healthcare financial, operational, and utilization metrics to assess cost trends, efficiency, and
performance outcomes.
The nature of the work requires progressive interpersonal communication, decision-making, financial and technical skills. Ability to ideate, improve processes, calculate measures, and leverage BI solutions to improve healthcare performance.
- Must exhibit the ability to function in an autonomous manner in a rapidly changing environment.
- High energy: strong leadership, analytical, project planning and coordination skills to enable efficient, timely task completion of deliverables that meet or exceed customer expectations.
- Demonstrated ability to function in a creative, "out-of-the-box" way of thinking to develop original solutions to overcome roadblocks and meet or exceed customer requirements and expectations.
- Knowledge of business intelligence applications, data, and tools.
- Advance analytical skills.
- Knowledge of medical claims data and managed care membership data.
- Knowledge of reimbursement (Commercial, Medicare, Medicaid) methodologies a plus.
Overview
HAP is a Michigan-based, nonprofit health plan that provides health coverage to individuals, Â Â Â Â Â companies and organizations. A subsidiary of Henry Ford Health System, we partner with doctors, employers and community groups to enhance the overall health and well-being of the lives we touch. With more than 1,100 dedicated and passionate employees, our goal is to make health care easy for our members.
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Under the leadership of President and CEO Robert G. Riney, Henry Ford Health is a
$6 billion integrated health system comprised of six hospitals, a health plan, and 250+ sites
including medical centers, walk-in and urgent care clinics, pharmacy, eye care facilities and
other healthcare retail. Established in 1915 by auto industry pioneer Henry Ford, the health system
now has 32,000 employees and remains home to the 1,900-member Henry Ford Medical Group, one
of the nation’s oldest physician groups. An additional 2,200 physicians are also affiliated with the
health system through the Henry Ford Physician Network. Henry Ford is also one of the region’s Â
major academic medical centers, receiving between $90-$100 million in annual research funding and
remaining Michigan’s fourth largest NIH-funded institution. Also an active participant in medical
education and training, the health system has trained nearly 40% of physicians currently practicing
in the state and also provides education and training for other health professionals including nurses,
pharmacists, radiology and respiratory technicians. visit HenryFord.com.
Benefits
Whether it's offering a new medical option, helping you make healthier lifestyle choices or
making the employee enrollment selection experience easier, it's all about choice. Â Henry
Ford Health System has a new approach for its employee benefits program - My Choice
Rewards. Â My Choice Rewards is a program as diverse as the people it serves. Â There are
dozens of options for all of our employees including compensation, benefits, work/life balance
and learning - options that enhance your career and add value to your personal life. Â As an
employee you are provided access to Retirement Programs, an Employee Assistance Program
(Henry Ford Enhanced), Tuition Reimbursement, Paid Time Off, Employee Health and Wellness
and access to day care services at Bright Horizons Midtown Detroit, and a whole host of other
benefits and services. Employee's classified as contingent status are not eligible for benefits
Equal Employment Opportunity/Affirmative Action Employer
Equal Employment Opportunity / Affirmative Action Employer Henry Ford Health System is
committed to the hiring, advancement and fair treatment of all individuals without regard to
race, color, creed, religion, age, sex, national origin, disability, veteran status, size, height,
weight, marital status, family status, gender identity, sexual orientation, and genetic information,
or any other protected status in accordance with applicable federal and state laws.