Director, Medical Economics

Summary: This position provides critical support to the Chief Actuary and other members of the Senior Leadership team in their development of strategies to achieve key corporate goals.  Among other duties, this position is responsible for the development and clear presentation of various statistical data, and by thoroughly analyzing this historical information, predicting future results in profitability, enrollment, medical utilization and cost, and other significant areas. This position is responsible for the performance of detailed analytics which provide management with a sound understanding of actual results and the main drivers of such performance. This position is also responsible for the determination and production of key business metrics to support many areas. This position ensures that appropriate and consistent analysis is performed across all analytic teams,  and that core work under reporting and analytics is aligned with the goal of improving product value and ensuring customer expectations are met or exceeded.  This position translates business questions into appropriate statistical or analytical requirements, and directs others to resolve highly complex or unusual business problems that affect major functions or disciplines. 
 
Responsibilities:
• Hires, develops, manages and motivates a performance-based medical economics team, providing ongoing direction, leadership, evaluation, training and development of staff to maximize return and drive results.
• Responsible for the analysis of health care data to identify trends, explain plan results, and uncover and investigate problems and opportunities for plan improvement. Communicates findings to senior management and the appropriate stake-holders.
• Responsible for the design, production, and analysis of detailed statistical reports regarding line of business profitability, with key findings highlighted and presented clearly so that appropriate decisions  can be made.
• Responsible for the development of models that identify the causes for variation in medical costs, and the development of reports that summarize this information effectively so that appropriate actions can be taken.
• Responsible for the development of “what if” analysis models that will predict financial outcomes of various business decisions, and for the reporting of the impact of these decisions to determine if the original cost and savings projections were achieved.
• Responsible for the development of predictive analytics modeling to assist the company in effectively understanding future cost of care trend drivers and their financial and pricing impacts.
• Responsible for root cause analysis exercises to identify potential recovery/avoidance opportunities from problems due to undiscovered system or other issues.
• Responsible for the support of the Pricing and Valuation Department with the quantification of the impacts of Federal health Care Reform and other legislation.
• Responsible for the development of case studies designed to understand future health care cost trends, which can originate from other studies performed in the health care industry, but which utilize company data and compare the company to the industry.
• Participate in the process of vetting, testing, and implementing enterprise reporting and analysis tools.
• Responsible for the development and performance of risk classification analysis of the company’s book of business and various segments of the enrolled membership to support pricing, underwriting, marketing, and sales strategies.
• Responsible for ad hoc data mining, reporting, and analytic tasks to help various areas of the company achieve departmental or company goals.
• Perform other related projects and duties as assigned.