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Medical Economics Consultant id-9080

Horizon Blue Cross Blue Shield of New Jersey empowers our members to achieve their best health. For over 90 years, we have been New Jersey's health solutions leader driving innovations that improve health care quality, affordability, and member experience. Our members are our neighbors, our friends, and our families. It is this understanding that drives us to better serve and care for the 3.5 million people who place their trust in us. We pride ourselves on our best-in-class employees and strive to maintain an innovative and inclusive environment that allows them to thrive. When our employees bring their best and succeed, the Company succeeds.

This position is responsible for Value Based Program analytics, future program evolution and development. Responsibilities include the build and on-going reporting of analytics data to develop value-based programs, targets, and payments for OMNIA and other partners and the on-going management & assessment of these programs; Alliance/Value Based Program Partner program presentation development; and the management of key HCM operational reviews, including the Monthly Operating Review (MOR) and METEOR 2.0 which is presented to HCM senior leaders and related division senior leadership. Coordinate and produce financial reporting and lead analytical activities that support P&L evaluation consistent with the business management process. Drive the effective development and tracking of key division medical cost savings action plans and strategic investments. Present these action plans and strategic investments to HCM senior leaders. A key responsibility will be to interface and manage cross-functional initiatives as well as present to external parties such as but not limited to Alliance Partners. Key areas of focus will include: developing a comprehensive understanding of the composition of monthly and year-to-date revenue and medical costs, including the identification of key variance factors between actual results and divisional and related enterprise-wide budget. This understanding will lead to this position interfacing and collaborating across the enterprise to lead, analyze and evaluate key initiatives that will drive profitable segment performance. As such, present and review for assessment by actuarial and underwriting in determination of future program costing. This position will also establish and manage the comprehensive behavioral health reporting and analytics management process which will support the Value Based Program transformation and the Organized Systems of Care initiatives.

Responsibilities:



Education/Experience:

  • Prefers a Bachelors degree from an accredited college or university, preferably in accounting, actuarial, finance or a related field. In lieu of degree, relevant work experience required.
  • Requires a minimum of 8 years of experience in health care/managed care with direct responsibility within a Financial Planning & Analysis (FP&A) and/or Medical Cost Management & Analysis discipline.
  • Requires minimum of 5 years of experience in developing complex financial models in order to drive analyses that will support business decisions.
  • Requires a demonstrated progressive understanding of managed care business processes, data, systems, and applications for claims payment, enrollment, benefit design, product pricing, network and provider contracting, and utilization management.
  • Requires a minimum of 5 years of demonstrated experience collaborating effectively with business partners such as Analytics, Actuaries, FP&A, and/or Medical/Rx/Clinical Operations in order to develop solid skillsets with the following disciplines: medical cost analysis, development/validation/tracking of medical cost action plans, return-on-investment scenarios, market segment premium development, monthly financial reporting and variance analysis, annual business plan/budget development and presentations to management.
  • Requires demonstrated technical skills with database concepts, data analysis development, data warehousing, and data extraction tools (ex. SAS, SQL).
  • Requires demonstrated understanding of P&L management principals, actual versus budget variance analysis, and general knowledge of budgeting and planning principals.



Knowledge:

  • Requires general knowledge of the components underneath medical cost and utilization trends, as well as how to appropriately presents year-over-year comparisons to specifically identify variances/changes to budget and prior year.
  • Requires knowledge of Commercial and Medicare market sectors and products.
  • Requires knowledge of healthcare/managed care industry operations and products and how they relate to key metrics within financial statements.
  • Requires knowledge of Horizons membership and claims databases and the tools to effectively and efficiently navigate through such databases.
  • Requires process mapping capabilities experience in order to develop new methodologies to achieve a desired end result.
  • Requires demonstrated quantitative and financial analysis skills



Skills and Abilities:

  • Must be proficient in the use of personal computers and supporting software in a Windows based environment, including MS Office products (Word, Excel, PowerPoint) and Outlook. Should be knowledgeable in the use of intranet and internet applications.
  • Requires the ability to express thoughts clearly and concisely, both verbally and in writing.
  • Requires a demonstrated aptitude for analytical thinking and the ability to report findings in an accurate manner.
  • Requires the ability to research and resolve problems through interaction with company-wide personnel.
  • Requires the ability to work independently with minimal direct supervision and exercise sound business judgment.
  • Requires advance knowledge of Excel.
  • Requires experience with Word and PowerPoint.



Horizon BCBSNJ employees must live in New Jersey, New York, Pennsylvania, Connecticut or Delaware

Salary Range:
$96,300 - $131,565

This compensation range is specific to the job level and takes into account the wide range of factors that are considered in making compensation decisions, including but not limited to: education, experience, licensure, certifications, geographic location, and internal equity. This range has been created in good faith based on information known to Horizon at the time of posting. Compensation decisions are dependent on the circumstances of each case. Horizon also provides a comprehensive compensation and benefits package which includes:

  • Comprehensive health benefits (Medical/Dental/Vision)
  • Retirement Plans
  • Generous PTO
  • Incentive Plans
  • Wellness Programs
  • Paid Volunteer Time Off
  • Tuition Reimbursement.
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