Highmark Health: Medical Economics Consultant
Highmark Health is seeking a Medical Economics Consultant to support its Advanced Analytics and Reporting Department.
Highmark Health is seeking a Medical Economics Consultant to support our Advanced Analytics and Reporting Department. The incumbant is responsible the development, coordination and management of medical economics analysis, models, health outcome studies and related forecasting and actual results analysis related to the portfolio of activities that are focused on operating margin improvements, primarily focused on medical spend. This work will leverage market-leading health plan medical economics processes, tools and reporting.
This key new role will serve as the key link between the Finance/Actuarial work in support of these initiatives and each business segment and functional area partners’ work, with focus on:
1) the coordination of infrastructure development to link initiatives with financial plans/forecasts, emerging results and pricing
2) infrastructure and process development to link medical economic related analytics (trend reporting, medical cost, conditions, etc.) with business partner actions, including progress and impact and
3) function as point person for all business segment medical economic analytics. This position will be required to manage the matrix- specifically business partners and those support functions- who have accountability to implement initiatives in the portfolio. This particular opening is a new position that has been created specifically to serve as part of the foundation for governance and management of this mission critical operating margin improvement effort.
The position will report into the Health Plan Finance Organization; however, significant emphasis will be placed on frequent and meaningful interactions with business segment and functional department executive/senior leadership to ensure that earnings improvement initiatives are identified and executed in a timely manner. As such, the position will interact with Health Plan Management (SVPs, VPs, Directors, etc.) in formal and informal situations, and must demonstrate a high-level of analytical, communications and influence skills.
Essential Job Functions:
- Coordinate the oversight and monitoring of the Health Plan “Creating Customer Value” operating margin improvement effort, driving cross-functional team work efforts to identify, design, implement and monitor initiatives that improve the Organization’s revenue, claims and administrative expenses:
- Use medical economics experience and knowledge to facilitate idea generation and quantification of savings initiatives (areas of focus include provider contracting, utilization management, care management, risk adjustment, operational efficiencies, product design, etc.).
- Provide timely insight into claim cost drivers for the business segment leaders and identification of new improvement opportunities.
- Understand the larger medical cost picture, and create process to identify and quantify interactions and dependencies of the different initiatives.
- Partner with Market Segment Finance, Actuary, FP&A and the business and functional partner leaders to ensure that the initiatives are appropriately contemplated in current/future year projections and pricing models as well as monitored in the emerging financial results.
- Coordinate savings opportunity projections and post implementation savings measurement with other areas
- Regularly interact with Senior Finance leadership, including the Chief Actuary and CFO of the Health Plan as well as other leadership and staff, to set and adjust overall goals and objectives of the process.
- Provide greater ability to more timely engage, analyze, and implement beneficial but complex financial arrangements with new vendor business partners.
- Develop improved business case and savings estimate capabilities to enable more accurate and deeper projections.
- Influence other departments where you do not have direct authority.
- Help drive a culture change from “reporting the past” to “creating the solutions for future.”
- Be persistent in following up with senior management and staff from numerous departments.
- Collaborate with P&L owners and functional leaders. This will require strong communication skills (verbal and executive quality presentations).
- Be able to determine when projections seem unreasonable and constructively push back until satisfied with the analysis.
- Bachelor’s degree
- 5+ years’ progressive experience in finance, accounting or analytics/informatics in the health care payer sector with a focus on medical economics
- Master’s degree
Knowledge, Skills & Abilities:
- Medical economics
- Financial analysis/modeling
- Statistical/quantitative modeling
- Executive communication
- Direct report development/talent management
- Collaboration across matrix organizational structure
Referral Award Payout Level: 4