Senior Analyst, Medical Economics - Senior Analyst, Medical Economics (Trend Analytics, SQL, Power BI, Medicaid) - REMOTE

JOB DESCRIPTION

Job Summary

Provides senior-level analytical support for Medical Economics initiatives through the extraction, analysis, and synthesis of complex healthcare data to identify risks, opportunities, and drivers of medical cost and utilization trends. Responsible for developing actionable insights that enhance financial performance, support strategic decision-making, and improve cost of care outcomes. Partners with cross-functional teams to identify, quantify, and monitor emerging trends, develop Scorable Action Items (SAIs) and affordability initiatives, and recommend innovative cost containment strategies. Translates analytical findings into clear, business-focused recommendations that drive operational improvements, medical cost savings, and sustainable financial results. Success in this role requires deep analytical expertise, strong healthcare industry knowledge, and the ability to influence decision-making through accurate, timely, and meaningful analysis.

Essential Job Duties

• Analyzes claims, authorization, and other data sources to identify early signs of trends or other issues related to medical care costs.
• Analyzes trends by proactively identifying and investigating complex suspect areas regarding medical cost issues, initiating in-depth analysis of suspect/problem areas and suggesting corrective action plans.
• Analyzes the financial performance, including PMPM, unit cost, utilization and revenue of all Molina products - identifying favorable and unfavorable trends, developing recommendations to improve trends and communicating recommendations to leadership.
• Draws actionable conclusions based on analyses performed, makes recommendations through use of health care analytics and predictive modeling, and communicates those conclusions effectively to audiences at various levels of the enterprise.
• Performs pro forma sensitivity analyses in order to estimate the expected financial value of proposed medical cost improvement initiatives.
• Collaborates with clinical, provider network and other teams to bring supplemental context/insight to data analyses, and design finance modeling to size and track key performance indicators of medical interventions.
• Leads projects to completion by contributing to ad-hoc data analyses, development, and presentation of financial reports.
• Provides data driven analytics to finance, claims, medical management, network, and other departments to enable critical decision making.
• Utilizes Molina data warehouses to extract data needed for trend analysis and cost reduction initiatives utilizing SQL environment.
• Supports financial analysis projects related to medical cost reduction initiatives.
• Supports medical management by assisting with return on investment (ROI) analyses for vendors to determine if financial and clinical performance is achieving desired results.
• Keeps abreast of Medicaid and Medicare reforms and impact on the Molina business.
• Supports scoreable action item (SAI) initiative tracking to performance.
• Designs and develops reports to monitor health plan performance and identify the root causes of medical cost trends - with root causes identified, drives innovation through creation of tools to monitor trend drivers and provides recommendations to senior leaders for affordability opportunities.
• Proactively identifies and investigates complex suspect areas regarding medical cost issues, initiates in-depth analysis of suspect/problem areas and suggests corrective action plans.

Required Qualifications
• At least 3 years of health care analytics and/or medical economics experience, or equivalent combination of relevant education and experience.
• Bachelor’s degree in statistics, mathematics, economics, computer science, health care management or related field.
• Demonstrated understanding of Medicaid and Medicare programs or other health care plans.
• Analytical work experience within the health care industry (i.e., hospital, network, ancillary, medical facility, health care vendor, commercial health insurance, large physician practice, managed care organization, etc.)
• Proficiency with retrieving specified information from data sources.
• Experience with building dashboards in Excel, Power BI, and/or Tableau and data management.
• Knowledge of health care operations (utilization management, disease management, HEDIS quality measures, claims processing, etc.)
• Knowledge of health care financial terms (e.g., PMPM, revenue) and different standard code systems (ICD-10CM, CPT, HCPCS, NDC, etc.) utilized in medical coding/billing (UB04/1500 form).
• Demonstrated understanding of key managed care concepts and provider reimbursement principles such as risk adjustment, capitation, FFS (Fee-for-Service), Diagnosis Related Groups (DRG’s), Ambulatory Patient Groups (APG’s), Ambulatory Payment Classifications (APC’s), and other payment mechanisms.
• Understanding of value-based risk arrangements
• Experience in quantifying, measuring, and analyzing financial, operational, and/or utilization metrics in health care.
• Ability to mine and manage information from large data sources.
• Demonstrated problem-solving skills.
• Strong critical-thinking and attention to detail.
• Ability to effectively collaborate with technical and non-technical stakeholders.
• Strong time-management skills, and ability to manage simultaneous projects and tasks to meet internal deadlines.
• Effective verbal and written communication skills.
• Proficient in Microsoft Office suite products, key skills in Excel (VLOOKUPs and pivot tables)/applicable software program(s) proficiency.

Preferred Qualifications

• Proficiency with Power BI and/or Tableau for building dashboards.
• Proficiency in SQL and/or other programming languages with the ability to write, optimize, and execute complex queries to extract, analyze, and validate data.

To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board.

Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V