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16177 Requisition #
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Commercial Analytics” area is comprised of the below three core teams:


 


Risk and Care Analytics


  • Provides analytical support and insights to drive strategy, ensure compliance, and evaluate effectiveness of revenue program initiatives and campaign operations in support of the Affordable Care Act (ACA) Risk Adjustment program


  • Conducts analysis to support clinical care operations (medical and pharmacy), customer segmentation, and actionable results and insights that improve the health of our members


Provider Performance


  • Provides analysis in support of provider contracting strategies/negotiations and financial performance including impact of network acquisitions, terminations, and contractual arrangements


  • Examines and monitors provider performance and trends in support of forecasting, pricing, and product development


Value Based Providers


  • Develops analytics to drive opportunities on alternative payment programs or value based programs, including but not limited to Accountable Care Organization’s and Patient Centered Medical Homes


  • Negotiates/Develops contracts, report on arrangements, and support provider relationships in support of forecasting, pricing, and product development

 


Job Summary



Manages a team through providing oversight, strategy implementation and execution for Analytics. This position will lead the design, planning, measurement, predictive analytic modeling and facilitate an evidenced based approach to drive decisions that enable the growth objectives of the business.


 


Essential Functions


  • The essential functions listed represent the major duties of this role, additional duties may be assigned.
  • Manage work to produce customer value by planning and forecasting, setting objectives and priorities, establishing goals, clarifying accountabilities, assigning work and utilizing management and financial controls.
  • Lead analysis, provide recommendations, and represent Analytics
  • Work closely with leaders across business areas to drive results across the business
  • Manage levels of performance and assist with employees’ professional growth by planning and building an effective organization; communicating effectively; coordinating with others; maintaining employee morale; motivating, recognizing and rewarding others; coaching and developing others, and engaging in self-development.
  • Manage business and public relationships and situations to obtain better business outcomes; communicate effectively and coordinate with others.
  • Develop, prioritize and implement strategy; set policies and procedures and manage creativity and innovation with primary goal of impacting health business

 


Required Skills:


  • 8+ years related work experience or equivalent combination of transferable experience and education.

  • 3+ years direct supervisory/management experience

  • Bachelor's degree required

  • Experience working with pricing and other key financial departments
    Experience working with statistical methodologies and risk adjusters
    Experience using algorithms and inferential statistics.
    Advanced level experience writing SQL /SAS or related code, performing quantitative healthcare cost analysis


Preferred Skills:


  • Bachelor’s degree in a related field Business Analytics, Health Economics or similar program
    Master’s degree in a related field

  • Experience working within the healthcare insurance industry (e.g., network contracting, clinical programs, etc.)



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