Senior Medical Economics Analyst

Responsibilities

• Support pricing validation, reconciliation modeling, and performance evaluation analyses
• Construct prospective and retrospective target-setting methodologies using difference-in-differences approaches, market benchmarking, credibility weighting, and risk-adjusted baselines
• Evaluate financial and quality performance across Commercial, Medicare Advantage, and Medicaid lines of business
• Develop and operationalize predictive models for cost, utilization, quality outcomes, and performance evaluation
• Support steerage, network optimization, and care management analytics
• Perform medical cost trend decomposition (unit cost vs. utilization vs. intensity vs. mix)
• Conduct risk-adjusted PMPM analysis across specialties, site-of-service, and population segments
• Analyze longitudinal performance across defined assessment periods
• Quantify impact of specialty utilization patterns and referral dynamics
• Evaluating acuity, case-mix, and coding impacts across populations
• Write advanced SQL queries to construct episode-level, provider-level, and member-month datasets

Requirements

• Bachelor's degree in a STEM field, with Master’s degree preferred, or equivalent work experience
• 5+ years of experience working within a payer or provider organization, or with healthcare analytics or care management organizations
• Demonstrated experience across Commercial, Medicare (including MA), and Medicaid populations
• Deep experience working the following types of data:
• Medical claims data
• Enrollment and eligibility data
• Provider data
• CMS revenue and risk adjustment data
• Value-based performance datasets
• Strong proficiency in SQL, Tableau, and Excel
• Experience utilizing Python or R is a plus

Position Perks

• FREE medical, dental, and vision insurance for employees on select plans
• $1740 annual contribution into qualifying HSAs
• UNLIMITED time off
• Matching 401(k) plan
• Mac laptop and accessories
• Company-paid short-term and long-term disability
• Company-paid life insurance
• Employee Assistance Program
• Annual professional development stipend

Position Perks

• Implementing and acting in accordance with the organization’s information security policies
• Protecting assets from unauthorized access, disclosure, modification, destruction, or interference
• Executing particular security processes or activities
• Ensuring responsibility is assigned to the individual for actions taken
• Reporting security events or potential events or other security risks to the organization