Manager, Medical Economics

About The Role

The Manager, Medical Economics is responsible for Matter Health’s membership and premium reconciliation functions. This leader ensures enrollment, eligibility, and capitation revenue are accurately reconciled across payer files, internal systems, and financial reporting processes. You will serve as the subject matter expert on membership and premium economics, partnering closely with Finance, Enterprise Information Management (EIM), and Operations to identify discrepancies, recover at-risk revenue, and improve data accuracy and integrity throughout the organization.

Key Responsibilities

• Lead the end-to-end membership reconciliation process, ensuring that enrollment, eligibility, and capitation payments are accurately tracked and reconciled across payer files, internal systems, and the general ledger.
• Investigate and resolve membership and premium variances, including retroactive additions, terminations, and rate changes.
• Quantify revenue at risk and collaborate with internal teams and health plans to recover discrepancies.
• Build and maintain business rules, controls, and data flows supporting member-month counts and premium accrual processes.
• Partner with Finance, Operations, and EIM teams to identify root causes and implement upstream data improvements.
• Produce monthly reconciliation reports and dashboards to give leadership visibility into membership, PMPM, and premium trends.
• Support month-end close activities by validating premium revenue and explaining membership and premium variances.
• Conduct independent analyses and present findings and recommendations to leadership.
• Design scalable reconciliation processes and prepare to support the growth of an analyst team.

Qualifications

• Bachelor’s degree in Statistics, Mathematics, Economics, Computer Science, Healthcare Management, or a related field.
• 7+ years of experience in healthcare analytics, medical economics, or premium/membership reconciliation.
• Experience with healthcare, managed care, health plans, value-based care organizations, or healthcare analytics environments.
• Strong expertise in Medicare Advantage, healthcare analytics, and/or medical economics.
• In-depth understanding of healthcare financial concepts, including PMPM, member months, capitation, premium accrual, and eligibility.
• Experience with enrollment and eligibility data, including payer files such as 834/820 transactions.
• Advanced Excel proficiency and the ability to independently analyze complex datasets.
• Ability to present analytical findings and recommendations to leadership.
• Strong analytical, problem-solving, communication, and relationship-building skills.

PREFERRED EXPERIENCE

• Experience with SQL.
• Experience in premium reconciliation processes.
• Managed care organization experience.
• Experience building dashboards in Power BI or Tableau.
• Knowledge of value-based care analytics and risk-based reimbursement models.
• Previous leadership or team management experience.