Medical Economics Lead Analyst

Bring your heart to CVS Health. Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand — with heart at its center — our purpose sends a personal message that how we deliver our services is just as important as what we deliver.
 
Our Heart At Work Behaviors™ support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable.

Position Summary

Job Description

We are seeking an analytical professional to join our Medical Economics - Medical Expense Review (MER) team. The primary goals of this team are to a) identify and communicate with leadership specific provider, procedure and population level trends and outliers impacting the health plans medical cost trends, and b) analyze and size potential savings initiatives in coordination with clinical, finance, and network leads.

Required Qualifications

Background/Experience

• Applicants must have relevant analytical financial experience.
• Minimum of 3-5 years’ experience with key managed care functions including provider and population analytics, provider contracting, benefit design, medical management as well as knowledge of business functions and impact on financials.
• Advanced skills in Excel, and Web-based query tools to pull and analyze ad-hoc data.
• Critical skills within Excel include use of pivot tables to sort and organize data, use of formulas for financial modeling and data tagging, and creation of data visualizations to effectively communicate the trend story
• Essential skill as reporting “super user” – able to easily navigate, comprehend, and tease out findings with a variety of enterprise reporting tools.
• Demonstrates critical thinking and expresses ideas clearly, concisely and logically from a cross functional perspective.
• Ability to manage conflicting priorities and multiple projects concurrently. Demonstrates initiative, innovation and leadership in achieving results.
• Ability to learn new technologies and analytic approaches.

Preferred Qualifications

• Skills within SQL Coding that may be beneficial will include ability to run ad-hoc analyses to answer specific clinical or financial questions for the Account, Finance, UM, or Network Teams.
• Extensive knowledge of managed care and how provider reimbursement policies relate to the control of medical claims costs.
• Full comprehension of provider contracts and the potential impact the regulatory/legislative environment has on reimbursement strategies.
• An understanding of the healthcare industry is strongly preferred, including differentiating between inpatient and outpatient services, facility and professional claims, and impacts from population dynamics.
• Underwriting, sales, product development, network management is also strongly preferred.
• SQL Coding experience preferred but not required.

Education

• Bachelor’s Degree in business, finance, or related field OR equivalent experience.

Pay Range

The typical pay range for this role is:

$60,300.00 - $139,200.00

This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls.  The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors.  This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. 
 
In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities.  The Company offers a full range of medical, dental, and vision benefits.  Eligible employees may enroll in the Company’s 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees.  The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long term disability benefits. CVS Health also offers numerous well-being programs, education assistance, free development courses, a CVS store discount, and discount programs with participating partners.  As for time off, Company employees enjoy Paid Time Off (“PTO”) or vacation pay, as well as paid holidays throughout the calendar year. Number of paid holidays, sick time and other time off are provided consistent with relevant state law and Company policies.