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.
Additional Details
This posting represents the major duties, responsibilities, and authorities of this job, and is not intended to be a complete list of all tasks and functions. It should be understood, therefore, that incumbents may be asked to perform job-related duties beyond those explicitly described above.
Overview
Henry Ford Health partners with millions of people on their health journey, across Michigan and around the world. We offer a full continuum of services – from primary and preventative care to complex and specialty care, health insurance, a full suite of home health offerings, virtual care, pharmacy, eye care and other health care retail. With former Ascension southeast Michigan and Flint region locations now part of our team, Henry Ford’s care is available in 13 hospitals and hundreds of ambulatory care locations. Based in Detroit, Henry Ford is one of the nation’s most respected academic medical centers and is leading the Future of Health: Detroit, a $3 billion investment anchored by a reimagined Henry Ford academic healthcare campus. Learn more at henryford.com/careers.
Benefits
The health and overall well-being of our team members is our priority. That’s why we offer support in the various components of our team’s well-being: physical, emotional, social, financial and spiritual. Our Total Rewards program includes competitive health plan options, with three consumer-driven health plans (CDHPs), a PPO plan and an HMO plan. Our team members enjoy a number of additional benefits, ranging from dental and eye care coverage to tuition assistance, family forming benefits, discounts to dozens of businesses and more. Employees classified as contingent status are not eligible for benefits.
Equal Employment Opportunity/Affirmative Action Employer
Equal Employment Opportunity / Affirmative Action Employer Henry Ford Health 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.