Company Statement

For the last 80 years, EmblemHealth has been taking care of New York’s heart and soul, its people. Today, health care is more complex than ever. That’s why we’re at the forefront of change. We work alongside our customers to offer access to high-quality, affordable care, help navigate the health care experience, and make good health achievable; because everyone deserves to be taken care of. We deliver on our mission every day by living our values with our colleagues, members, clients and partners. It begins with caring and respecting all those we work with. We believe a culture of diversity and inclusion is vital to serve our unique and diverse customers. We seek for continues improvement and innovation and believe being agile and nimble is our advantage. We bring a strong sense of partnership to every relationship – internally and externally. The EmblemHealth family of companies offers competitive health, welfare, and retirement benefits as well as incentive pay plans and more.


To protect the health and safety of our workforce, members, patients, and the communities we serve, the EmblemHealth family of companies require all new employees to be fully vaccinated for COVID-19. Exemption/reasonable accommodations may be granted because of 1) a qualifying medical condition or disability that makes getting the vaccine unsafe for the individual, or 2) objection on the basis of sincerely held religious beliefs and/or practices.

Lead Analyst, Medical Analytics

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Manager & Professional
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ConnectiCare
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Summary of Job:
Lead and direct the valuation of Health Care Cost Initiatives and Reimbursement Policy Costs as targets are identified. Provide critical support to the Senior Leadership team in their development of strategies to achieve goals for HealthCare Cost Containment Initiatives.  Responsible for the performance of detailed analytics which provide management with a sound understanding of actual results and the main drivers of such performance. Responsible for translating business questions into appropriate analytical requirements and directs others to resolve highly complex or unusual business problems that affect major functions or disciplines.  


Responsibilities:

  • Lead, mentor, develop, guide, or manage one or more staff members; serve as a resource and guide to enable the team to function effectively in performing valuation initiatives for HCCIs and RPC project requests.
  • Responsible for the development of models analysis to identify the causes for variation in medical costs, and the development of reports that summarize this information effectively so that appropriate actions can be taken.
  • Responsible for root cause analysis exercises to identify potential recovery/avoidance opportunities from problems due to undiscovered system or other issues.
  • Partner with staff to ensure accuracy and delivery of analytics to support leadership in driving data for performance.  
  • Provide analytical support to the Pharmacy reporting team; initiative valuations, trends, etc.
  • Provide subject matter expertise and technical support to maximize return and drive results for the medical economics team.
  • Monitor and track estimated and actual savings as it relates to HCCI in place and, document for review monthly with committee and business leads.  
  • Support the assessment of vendor performance, including evaluating return on investment and quantifying potential performance-based incentive payments.
  • Responsible for ad hoc data mining, reporting, and analytic tasks to help various areas of the company achieve departmental or company goals.
  • Responsible for supporting the Reimbursement Policy Committee with quantification of the impacts of proposed changes to provider reimbursement policies. Attend regularly scheduled meetings to support and participate in data review to identify impact of any changes.
  • Participate in the process of vetting, testing, and implementing enterprise reporting and analysis tools.
  • Responsible for the development of “what if” analysis that will predict financial outcomes of various business decisions, and for the reporting of the impact of these decisions to determine if the original cost and savings projections were achieved.
     

Qualifications:

  • Bachelor's Degree required, preferably in Actuarial Science/Mathematics/Finance/Economics or a related field.
  • 10+ years of experience in medical economics or analytics. (R)
  • Experience in a healthcare provider environment. (P)
  • Experience in managing processes and staff. (P)
  • Strong analytical skills with solid foundation in mathematical and statistical techniques. (R)
  • Additional years of experience/specialized training may be considered in lieu of educational requirements. (R)
  • Excellent oral and written communication and interpersonal skills. (R)
  • Strong, independent decision-making ability and negotiation skills. (R)
  • Ability to drive multiple priorities. (R)

EEOC Statement

We are committed to leveraging the diverse backgrounds, perspectives and experiences of our workforce to create opportunities for our people and our business. We are an equal opportunity/affirmative action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, protected veteran status or any other characteristic protected by law.

Sponsorship Statement

Depending on factors such as business unit requirements, the nature of the position, cost and applicable laws and regulations, EmblemHealth may provide work visa sponsorship for certain positions.

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