Senior Analyst, Medical Economics

JOB DESCRIPTION Job Summary Provides senior level analyst support for medical economics analysis activities, including extracting, analyzing and synthesizing data from various sources to identify risks and opportunities, and improve financial performance. Essential Job Duties u2022 Extracts and compiles data and information from various systems to support executive decision-making. u2022 Mines and manages information from large data sources. u2022 Analyzes claims and other data sources to identify early signs of trends or other issues related to medical care costs. u2022 Analyzes the financial performance, including cost, utilization and revenue of all Molina products - identifying favorable and unfavorable trends, developing recommendations to improve trends and communicating recommendations to leadership. u2022 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. u2022 Performs pro forma sensitivity analyses in order to estimate the expected financial value of proposed medical cost improvement initiatives. u2022 Collaborates with clinical, provider network and other teams to bring supplemental context/insight to data analyses, and design and perform studies related to the quantification of medical interventions. u2022 Collaborates with business owners to track key performance indicators of medical interventions. u2022 Proactively identifies and investigates complex suspect areas regarding medical cost issues, initiates in-depth analysis of suspect/problem areas and suggests corrective action plans. u2022 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. u2022 Leads projects to completion by contributing to ad-hoc data analyses, development, and presentation of financial reports. u2022 Serves as subject matter expert on developing financial models to evaluate the impact of provider reimbursement changes u2022 Provides data driven analytics to finance, claims, medical management, network, and other departments to enable critical decision making. u2022 Supports financial analysis projects related to medical cost reduction initiatives. u2022 Supports medical management by assisting with return on investment (ROI) analyses for vendors to determine if financial and clinical performance is achieving desired results. u2022 Keeps abreast of Medicaid and Medicare reforms and impact on the Molina business. u2022 Supports scoreable action item (SAI) initiative tracking to performance. Required Qualifications u2022 At least 3 years of health care analytics and/or medical economics experience, or equivalent combination of relevant education and experience. u2022 Bacheloru2019s degree in statistics, mathematics, economics, computer science, health care management or related field. u2022 Demonstrated understanding of Medicaid and Medicare programs or other health care plans. u2022 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.) u2022 Proficiency with retrieving specified information from data sources. u2022 Experience with building dashboards in Excel, Power BI, and/or Tableau and data management. u2022 Knowledge of health care operations (utilization management, disease management, HEDIS quality measures, claims processing, etc.) u2022 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). u2022 Demonstrated understanding of key managed care concepts and provider reimbursement principles such as risk adjustment, capitation, FFS (Fee-for-Service), Diagnosis Related Groups (DRGu2019s), Ambulatory Patient Groups (APGu2019s), Ambulatory Payment Classifications (APCu2019s), and other payment mechanisms. u2022 Understanding of value-based risk arrangements u2022 Experience in quantifying, measuring, and analyzing financial, operational, and/or utilization metrics in health care. u2022 Ability to mine and manage information from large data sources. u2022 Demonstrated problem-solving skills. u2022 Strong critical-thinking and attention to detail. u2022 Ability to effectively collaborate with technical and non-technical stakeholders. u2022 Strong time-management skills, and ability to manage simultaneous projects and tasks to meet internal deadlines. u2022 Effective verbal and written communication skills. u2022 Proficient in Microsoft Office suite products, key skills in Excel (VLOOKUPs and pivot tables)/applicable software program(s) proficiency. Preferred Qualifications u2022 Proficiency with Power BI and/or Tableau for building dashboards. 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 Pay Range: $77,969 - $155,508 / ANNUAL Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Created: 2025-12-15