Manager, Financial Health Data Analysis (11234)

Carrier Gov/Commercial

19The Opportunity

Manage the Financial Health Data Analysis function ensuring accurate, timely and useful financial and HEDIS reporting.  Report, analyze and forecast medical and drug costs.  Identify opportunities and actions to reduce such costs and develop measures for monitoring the savings generated by implemented actions. Analyze the financial impact of medical cost management initiatives.  Work with all areas of a company to identify, evaluate, implement, and monitor programs that reduce medical and drug costs.  Analyze and resolve complex issues pertaining to insurance pricing and experience monitoring. 

 

Responsibilities

• Assist in the development of and lead the MCAP (Medical Cost Action Program) along with other MCAP core team members.
• Report historic trend and analyze variances.
• Identify opportunities for claim savings.
• Estimate projected claim savings of cost management initiatives.
• Estimate financial impact to Blue Cross of Idaho (BCI) of cost management initiatives.
• Monitor the effect of cost management initiatives.
• Develop reporting measures to be used to report cost management savings to BCI customers.
• Present analyses to internal and external customers as required.
• Ensure the delivery of accurate, timely information from the Financial Health Data Analysis department that meets data specifications and analytical objectives.
• Establish department objectives that support corporate goals and produce regular status reports.
• Prepare an operating budget that reflects the forecasted needs of the department and control expenditures to assure adherence to approved budgets.
• Ensure effective workflows, maximize system efficiencies, monitor quality performance measures and confirm appropriate completion of work assignments.  Make recommendations for change as appropriate.
• Initiate personnel actions such as hiring, disciplinary, termination and/or salary recommendations.
• Participate in training, coaching and motivation of employees including career path development. Assess individual employee performance and conduct timely performance appraisals.
• Promote teamwork, discussion, and cooperation among staff and other departments.  Ensure timely communication and sharing of information with team members.
• Work with staff to resolve work-related issues and concerns. Promote a respectful and diverse workplace.
• Develop and maintain departmental policies and procedures.
• Perform other duties as requested by the Vice President.

 

Requirements

• Bachelor degree in analytical field including mathematics, statistics, calculus, and/or numerical analysis
• ASA, MAAA preferred
• Six years of experience in health insurance medical cost analysis
• Three years supervisory/management experience
• Health insurance company operation experience
• Medical and drug claim data elements knowledge
• Intermediate Microsoft Word and Excel
• Ability to clearly and concisely communicate highly technical issues, both orally and in written format
• Ability to query health care data proficiently in at least one computer language
• Ability to direct and review data extraction and reporting based on technical specifications required by governmental and other entities.