Manager Medical Economics & Business Process

Role Overview

The Manager, Medical Economics & Business Process leads a team responsible for delivering healthcare data and medical economics analyses across a variety of data sources, including claims, authorizations, member, and provider data. This role partners closely with cross-functional teams to structure and execute analyses, generate insights, and identify opportunities to improve medical costs, operational performance, and overall business outcomes. This is a hands-on role, which combines team leadership with active analytic contributions to core workstreams.

Responsibilities

• Lead complex analyses addressing healthcare cost, utilization, and operational performance using internal and external data sources.
• Demonstrate a comprehensive understanding of key drivers of healthcare trends and effectively synthesize complex concepts for diverse audiences.
• Serve as a trusted advisor to business partners by translating medical costs and operational insights into strategic opportunities and recommendations.
• Mentor, develop, and lead a high-performing analytics team focused on market-level and enterprise healthcare financial and operational data.
• Collaborate and build strong relationships with cross-functional partners to understand business questions and deliver actionable insights.
• Translate business needs into clear analytic requests and guide the development of appropriate methodologies.
• Design and develop innovative analytic solutions, tools, and approaches to address complex business problems.
• Work comfortably with large, complex, and diverse healthcare data sets to support decision-making and performance improvement.

Requirements

• Bachelor’s degree in actuarial science, economics, computer science, or a related field required.
• Master’s degree is preferred.
• 5 to 10 years of health plan analytics with in-depth analytics, technical expertise, and business knowledge.
• 5 years of experience presenting analytical results.
• 5 years of experience in healthcare data analysis and information reporting.
• 5 years of experience with SQL, Tableau, and PowerBI.
• Facilitation, decision-making, organizational/business expertise, and analytical skills.
• Leadership, supervisory, or team-leader experience.

Qualifications

• Strong understanding of Medicaid managed care, healthcare, and operational data.
• Advanced analytical and problem-solving skills with the ability to address complex business questions.
• Advanced capabilities in pulling, validating, and synthesizing data to derive actionable insights for the organization.
• Excellent verbal and written communication skills, with the ability to clearly convey insights to technical and non-technical audiences.
• Proven leadership and mentoring skills, with experience developing high-performing analytic teams.
• Strong organizational skills and ability to manage multiple priorities in a fast-paced environment.
• Able to think strategically while maintaining attention to detail and data accuracy.