Summary:

• Work with other team leaders to improve operational efficiencies and resource allocations for improved performance of the EmblemHealth plans.
• Responsible for running queries and providing required analysis to understand related drivers (such as medical cost and utilization), and to provide insightful commentary and sensitivity modeling analysis.
• Develop data-driven analysis for decision making on how EmblemHealth purchases, manages, and influences the cost of care for current and prospective members.
• Extract, analyze, and interpret data for more complex insights related to cost drivers and to manage the escalation of issues that impact costs, and impact of health cost containment initiatives.
• Provide consultative subject matter expertise to aligned business areas to demonstrate analytics rooted in data.

Responsibilities:

• Ensure data integrity is maintained throughout the reporting lifecycle.
• Implement reporting and reconciliation workflows and document processes.
• Responsible for experience studies and medical trend studies.
• Perform research and collection of data, including data mining and reporting, which is provided to various customers inside and outside the department.
• Implement automation of manual reporting and analysis of business implications and trends.
• Lead efforts to continually improve data capabilities and quality of department analysis and reporting.
• Create, develop, and design analytics and reporting to measure or estimate financial impact of health plan business problems and potential or actual solutions, addressing escalated issues with subject matter expertise.
• Lead and manage several corporate and health cost containment initiatives, supporting staffing to deliver results across all functions within Medical Economics including.
• Develop research and analytic processes to review financial data to draw conclusions for senior leadership.
• Represent the department to internal and external partners with presentation of data and results for use in administering specific programs and processes related to medical expense and utilization.
• Present analytical findings to internal business partners, leading discussions and providing delivery of further analysis.
• Analyze business problems related to financial experience of the health plan, particularly related to how care is purchased, managed, or other factors influencing cost of care.
• Perform additional duties as assigned.