Medical Economics Analyst II

About the Role

The Medical Economics Analyst II analyzes healthcare cost and utilization, identifies and models opportunities to improve performance and reduce medical costs, evaluates healthcare programs and interventions, and presents actionable analytical findings and recommendations to management.

Responsibilities

• Identify and quantify cost savings initiatives to reduce medical costs within the markets.
• Build financial models to quantify the impact of medical cost reduction initiatives.
• Assess overall health plan performance and perform root-cause analysis by analyzing medical cost, utilization trends, risk adjustment dynamics, revenue impacts, utilization management, and identifying key drivers, outliers, and opportunities for optimization.
• Combine strong technical skills in SQL and Excel/Power BI with critical thinking, business acumen, and the ability to refine and edit analyses for accuracy and clarity.
• Extract, manipulate, and validate large healthcare claims and prior authorization datasets using SQL and Microsoft Excel/Power BI.
• Develop tools to efficiently identify new opportunities for cost savings.
• Partner with various departments to discuss, develop, and solution medical cost reduction initiatives.
• Define appropriate populations, comparison groups, measures, and analytic methodologies to evaluate healthcare programs and interventions.
• Evaluate the efficiency and effectiveness of clinical programs, interventions, processes, and medical cost reduction initiatives.
• Present analytical findings and recommendations.
• Support the intake, prioritization, and coordinated execution of ad-hoc analytics requests from departments across the organization.
• Perform other job duties as requested.

Requirements

• Bachelor’s Degree or equivalent years of relevant work experience is required.
• Minimum of two (2) years of experience in healthcare analytics is required.
• Managed care experience is strongly preferred.

Skills

• Advanced knowledge of healthcare data, including medical and pharmacy claims, EMR data, HIE data, UM prior authorization data, care management data, and demographic data.
• Knowledge of Medicaid, Medicare, and other government-sponsored healthcare programs.
• Advanced Excel proficiency (pivot tables, lookups, financial modeling, data validation).
• Proficient SQL skills, including complex joins, aggregations, subqueries/CTEs, data validation, and working with large healthcare datasets.
• Familiarity with generative AI tools and their application to healthcare analytics, including use for analytical problem-solving, code development, research, and workflow efficiency.
• Ability to synthesize complex data into clear findings, conclusions, and actionable recommendations.
• Demonstrated ability to independently investigate healthcare cost and utilization questions, identify key drivers, validate findings, and develop actionable conclusions.
• Ability to balance competing priorities.
• Demonstrated written and verbal communication skills.

Working Conditions

General office environment; may be required to sit or stand for extended periods of time.

Pay

$72,200.00 - $115,500.00. Salary is determined by a combination of education, training, experience, the position’s scope and complexity, discretion and latitude required, and other external and internal data. In addition to base compensation, you may qualify for a bonus tied to company and individual performance.

Benefits

CareSource offers a substantial and comprehensive total rewards package focused on every employee’s total well-being.

Competencies

• Fostering a Collaborative Workplace Culture
• Cultivate Partnerships
• Develop Self and Others
• Drive Execution
• Influence Others
• Pursue Personal Excellence
• Understand the Business