Medical Economics Analyst – Health Plan

🔥 17 hours ago

🧀 Wisconsin – Remote

🧀 Wisconsin – Remote

💵 $29 - $46 / hour

⏰ Full Time

🟢 Junior

🧐 Analyst

🦅 H1B Visa Sponsor

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Sanford Health

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1894

🛡️ Insurance

🏥 Healthcare

⚕️ Healthcare Insurance

Insurance • Healthcare • Healthcare Insurance

Sanford Health is the largest rural health system in the United States, dedicated to transforming the healthcare experience and providing access to world-class healthcare in America's heartland. Headquartered in Sioux Falls, South Dakota, Sanford Health serves over 1. 4 million patients and nearly 200,000 health plan members across 250,000 square miles. The integrated health system includes 48 medical centers, 211 clinic locations, and more than 160 senior living centers, employing 2,900 physicians and advanced practice providers. Sanford Health is committed to offering compassionate care through its Centers of Excellence, focusing on specialties such as cancer, orthopedics, women’s health, and genetics. Additionally, it provides affordable health insurance, engages in extensive clinical trials, and supports personalized genetic medicine.

📋 Description

• Analyze complex medical claims, pharmacy data, and other healthcare data sets to identify emerging cost and utilization trends, patterns, and outliers • Develop financial models to evaluate the financial impact of new clinical programs, initiatives, and value-based agreements • Identify opportunities for medical cost reduction, quantify potential savings, and measure ROI of implemented initiatives • Create reports, dashboards, and presentations using data visualization tools • Communicate findings and actionable insights to senior management and clinical departments • Collaborate with accounting, actuarial, underwriting, clinical, health services delivery, and network management teams • Provide analytical support for decision-making and strategic planning, including payer negotiations and risk adjustment strategies • Ensure accuracy and integrity of data used in analyses • Prepare project documentation including methodologies and key decision points • Respond to ad-hoc data analysis requests from various departments

🎯 Requirements

• Bachelor’s degree in Economics, Statistics, Finance, Public Health, Mathematics, Actuarial Science, Data Analytics or related quantitative discipline required • 1-3 years of progressive analytical experience in a healthcare setting (health insurance, managed care, or health system) required • Knowledge of STARs and Risk Adjustment preferred • Strong analytical, problem-solving, critical thinking, and communication skills • Proficiency in SQL for data extraction and manipulation • Advanced Microsoft Excel skills, including pivot tables and complex formulas • Experience with data visualization tools like Tableau or Power BI highly valued • Familiarity with statistical tools such as SAS, R, or Python is a plus