Medical Economics Analyst

Horizon Blue Cross Blue Shield of New Jersey empowers our members to achieve their best health.  For over 90 years, we have been New Jersey’s health solutions leader driving innovations that improve health care quality, affordability, and member experience.  Our members are our neighbors, our friends, and our families.  It is this understanding that drives us to better serve and care for the 3.5 million people who place their trust in us. We pride ourselves on our best-in-class employees and strive to maintain an innovative and inclusive environment that allows them to thrive. When our employees bring their best and succeed, the Company succeeds. 

The position is primarily responsible for driving and producing various financial reporting and analytical activities that support Healthcare Management's P&L evaluation on routine basis that lead to key medical cost savings action plans. Key focus areas include developing a detailed understanding of the composition of monthly and year-to-date revenue and medical cost, including identifying the key variance factors between Actual results and Budget. In addition this position will also have responsibility within Value Based Program analytics, Alliance/Value Based Program Partner presentation development and the coordination and completion of the HCM Monthly Operating Review (MOR). This includes, but is not limited to aspects of medical cost performance including utilization, unit cost, vendor programs and value-based reimbursement.

Responsibilities:

• Works within Health Care Management to provide analysis to inform the strategic focus for the identification and implementation of network and medical cost management strategies.

• Develops and monitors a series of metrics and reports related to medical cost performance.

• Works closely with the Value Based Program team to understand the operations of the program including attributed membership and shared savings calculations and supports the integrity of the Program through objective review and validation.

• Develops and leads key Healthcare Management Reporting on a monthly basis aimed at the presenting and understanding of specific HCM P&L performance including, but not limited to (i) Variance Analysis/Commentary Actual vs Budget/Plan and Prior Year (ii) Revenue detail and components (iii) Medical Cost detail and components (iv) Product Mix (v) Market Segments.

• Leads the coordination and consolidation of the HCM Monthly Operating Review (MOR).

• Gathers and utilizes analytics from multidisciplinary teams to develop and evaluate the performance of existing medical cost activities across Health Care Management and consults with business leaders on observations and recommendations.

• Provide support to the Value Based Program analytics initiatives through data mining and extraction, report and presentation design, financial modeling, identification of medical cost trend drivers, and consolidation of medical action plans.

• Implement analytic tools and techniques to identify cost drivers and ways to improve medical cost performance.

• Evaluates the feasibility of strategic initiatives and new business opportunities. This includes providing support in developing financial program scenarios for current and potential Value Based Program partners related to program evolution or customization. Actively participates within the development of the future state of Value Based Programs.

• Works in multidisciplinary teams to identify, quantify return on investment, and track medical cost reduction initiatives. This includes within HCM and coordinating with finance and actuarial team to connect medical cost activities to the enterprise financial process.

Education/Experience:

• High School Diploma/GED required.

• Bachelor degree in accounting or finance preferred or relevant experience in lieu of degree.

• Requires a minimum of 3-5 years of experience in health care/managed care with direct responsibility within a Financial Planning & Analysis (FP&A) and/or Medical Cost Management & Analysis discipline.

• Requires a progressive understanding of managed care business processes, data, systems, and applications for claims payment, enrollment, benefit design, product pricing, network and provider contracting, and utilization management.

• Experience working closely with business partners such as Analytics, Actuaries and/or FP&A in order to develop solid skillsets with the following disciplines: medical cost analysis, market segment premium development, monthly financial reporting and variance analysis, annual business plan/budget development and presentations to management.

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