Iselin , NJ 08830
Provides financial support in the analysis of medical expenses, medical expense trend, membership, revenue, medical loss ratio and drill downs.
Provides analysis of revenue and medical costs on a restated basis and/or paid basis to facilitate identification of actionable trend drivers and cost of care initiative
Provides analysis of Clinical data to support process improvements leading to Cost of Care savings.
Independently develops sound applications and models necessary to efficiently measure, understand, monitor and explain the plans medical cost structure and restated financial results.
Proactively identifies medical expense trend opportunities and risks throughout the plan such as trend anomalies, outliers, behaviors etc.
Utilizes all available tools and applications to facilitate the development of actionable information to create performance improvement
Completes the most diverse and complicated projects and performs complex analytical studies.
Prepares comprehensive documented observations, analyses and interpretations of results including technical reports, summaries and quantitative analyses.
Present medical cost trends to a wide audience on a regular basis.
Consults with Plan leadership, including P&L, Segment, Provider Contracting, Clinical, Claims Processing and Finance on analyses and recommendations regarding appropriate courses of actions. Other key competencies:
Leadership, communication and presentation skills.
Trust-building: Honor your word by doing what you say you are going to do.
Implementation/Execution: Good at organizing and managing multiple priorities and/or projects by using appropriate methodologies and tools.
Innovative: Introduce new ideas and processes which improve performance and productivity.
Willing to learn; and a quick learner.
Problem-solving: Solve problems with the ability to encourage others in collaborative problem solving. Act as both a broker and consultant regarding resources; engage others in problem solving without taking over. / Anthem, Inc. is ranked as one of Americas Most Admired Companies among health insurers by Fortune magazine and is a 2016 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company and apply, please visit us at antheminc.com/careers. EOE. M/F/Disability/Veteran. / Qualifications for Provider Contract /Cost of Care Consultant
BS/BA degree in Mathematics, Statistics, or related field. * 5 years experience in broad-based analytical, managed care payor or provider environment.
Considerable experience in statistical analysis and healthcare modeling.
Any combination of education and experience, which would provide an equivalent background.
Master's degree preferred.
Progressive data analysis and reporting experience.
Proficiency with Microsoft Excel and VBA. * 3 years of experience in managed healthcare analytics is strongly preferred. * 3 years of experience in Medicaid or Medicare is preferred. * SQL experience is required.
Advanced Excel knowledge is required.
Familiarity with claims data and authorization data experience preferred. * SAS experience preferred.
Job *Reporting & Data Analysis
Title:Healthcare Economincs Consultant (Prov Contract/CofC Consult) - (NH preferred) - 131441
Other Locations:New Hampshire