The job will partner with business leadership by providing strategic insight using medical cost analytics. Enable medical cost programs by providing analytics to support business outcomes by 1) analyzing the value of their programs, 2) tracking the outcomes of the programs, and 3) providing strategic insight into areas of focus/opportunities. The goal of this role is to be a partner to the functional areas of the business in helping define the strategy of their go to market approach in impacting medical cost. This position will lead the development, coordination and management of medical economics analysis, medical cost models, health outcome studies and related forecasting and actual results analysis related to the portfolio of activities that are focused on improving medical cost outcomes. This work will leverage market-leading health plan medical economics processes, tools and reporting. This role will serve as the key link between the Finance/Actuarial work in support of these initiatives and each business segment and functional area partners’ work, with focus on 1) the coordination of infrastructure development to link initiatives with financial plans/forecasts, emerging results and pricing 2) infrastructure and process development to link medical economic related analytics (trend reporting, medical cost, conditions, etc.) with business partner actions, including progress and impact and 3) function as point person for all business segment medical economic analytics. The job will be required to oversee and influence the matrix- specifically business partners and those support functions- who have accountability to implement initiatives in the portfolio. This particular opening is a new position that has been created specifically to serve as part of the foundation for governance and management of this mission critical operating margin improvement effort. The position will report into the Health Plan Finance Organization; however, significant emphasis will be placed on frequent and meaningful interactions with business segment and functional department executive/senior leadership to ensure that earnings improvement initiatives are identified and executed in a timely manner. As such, the position will interact with Health Plan Management (SVPs, VPs, Directors, etc.) in formal and informal situations, and must demonstrate a high-level of analytical, communications and influence skills.
- Responsible for Medical Cost Initiatives to include: (a) Partner with business leadership by providing strategic insight using medical cost analytics. Partner with functional areas of the business in helping define the strategy of their go to market approach in impacting medical cost, (b) Understand the larger medical cost picture, and create process to identify and quantify interactions and dependencies of the different initiatives; (c) Partner with Market Segment Finance, Actuary, FP&A and the business and functional partner leaders to ensure that the initiatives are appropriately contemplated in current/future year projections and pricing models as well as monitored i+n the emerging financial results, (d) Coordinate savings opportunity projections and post implementation savings measurement with other areas, (e) Train business partners in the use of business case return on investment measurement, developing a self-service culture that enables a broad base of support to initiative owners in their efforts to identify potential operating margin improvement initiatives, and (f) Develop improved business case and savings estimate capabilities to enable more accurate and deeper projections.
- Business/Segment Medical Cost Analytics: (a) Leverage medical economics experience and knowledge to provide medical cost analytics to help facilitate idea generation and quantification of savings initiatives (areas of focus include provider contracting, utilization management, care management, risk adjustment, operational efficiencies, product design, etc.), (b) Present medical cost analytics and insight into claim cost drivers for the business segment leaders, (c) Regularly interact with Senior Finance leadership, including the Chief Actuary and CFO of the Health Plan as well as other leadership and staff, to set and adjust overall goals and objectives of the process, and (d) Provide greater ability to more timely engage, analyze, and implement beneficial but complex financial arrangements.
- Help develop and implement improved infrastructure and processes to provide Health Plan and Enterprise management with regular performance scorecards highlighting initiative implementation successes, accountability, ‘capture’ of initiative benefits, activity, progress and identification of barriers.
- Consistently work with Health Plan business and functional area partners to develop a pipeline of new initiatives, seeking to achieve our multi-year financial improvement targets. This effort focused on operating margin improvement is positioned to become a normal part of the way the Health Plan does business, and will exist on-going every year.
- Lead in a matrixed work environment: (a) Influence other departments where you do not have direct authority, (b) Help drive a culture change from ‘reporting the past’ to ‘creating the solutions for future, (c) Be persistent in following up with senior management and staff from numerous departments, (d) Collaborate with P&L owners and functional leaders. This will require strong communication skills (verbal and executive quality presentations), (e) Be able to determine when projections seem unreasonable and constructively push back until satisfied with the analysis.
- Responsible for mentoring, training and providing subject matter expertise to Medical Economics Consultants.
- Other duties as assigned or requested.
- Bachelor’s Degree in Business, Health, Economics, or other related area
- Master’s Degree in Business, Health, Economics, or related field
- 7 years of experience in Finance, Accounting, Analytics, and/or Informatics in the health care payer sector to include 5 years of Medical Economics/Healthcare Analytics experience and 3 years of Statistical/Quantitative Modeling experience
- Strong PC Application skills (MS Office, SAS / SQL)
- Demonstrated ability to liaison directly with business partners (Vice Presidents) and above in driving communication of analytics, strategic trade-offs, and new approaches to breaking down analytics
- Verbal and Written Communication skills
- Organizational skills
- analytical ability
- Executive Communications
- Talent Management / Development
- Collaboration across matrixed organizational structure
- Knowledge of healthcare Industry trends and challenges