Medical Economics Analyst, Health Plan

Medical Health Economics Analyst

Sanford Health, the largest rural health system in the United States, is dedicated to transforming the health care experience and providing access to world-class health care in America's heartland. This position is remote in Wisconsin and is full time with a weekly schedule of 40 hours. The salary range is $29.00 - $46.50.

The Medical Health Economics Analyst uses data analysis to identify medical cost trends, evaluate financial performance, and provide actionable insights to support strategic business decisions. This role is vital for cost containment and improving plan performance. 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, new initiatives, and value-based agreements. Identify opportunities for medical cost reduction, quantify potential savings, and measure the return on investment (ROI) of implemented initiatives. Create clear, concise reports, dashboards, and presentations using data visualization tools to communicate complex findings and actionable insights to a variety of stakeholders, including senior management and clinical departments. Work closely with accounting, actuarial, underwriting, clinical, health services delivery and network management teams to provide analytical support for decision-making and strategic planning, such as informing payer negotiations and risk adjustment strategies. Ensure the accuracy and integrity of data used in analyses, and prepare well-organized project documentation including methodologies and key decision points. Respond to ad-hoc data analysis requests from various departments, providing timely intelligence related to specific business problems.

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) is required. Knowledge of STARs and Risk Adjustment preferred. Strong analytical, problem-solving, critical thinking, and communication skills are vital for success in this role. Proficiency in SQL for data extraction and manipulation is a must. Advanced Microsoft Excel skills, including pivot tables and complex formulas, are essential. Experience with data visualization tools like Tableau or Power BI is highly valued. Familiarity with statistical tools such as SAS, R, or Python is often a plus.

Sanford offers an attractive benefits package for qualifying full-time and part-time employees. Depending on eligibility, a variety of benefits include health insurance, dental insurance, vision insurance, life insurance, a 401(k) retirement plan, work/life balance benefits, and a generous time off package to maintain a healthy home-work balance.