Dec 06, 2019

Medical Economics Analyst

  • Professional Diversity Network
  • Detroit, MI, USA
Full-Time Finance

Job Description

WellCare Health Plans

Position will extract, analyze and interpret data to produce both standard claims and utilization trend reporting and ad hoc analysis requests. Supports all functions within Medical Economics including monitoring of specific corporate and health quality & affordability initiatives. (HQAI's).

Essential Functions:

  • Supports research and analysis of financial data, draws conclusions and provides consultation to internal and external partners for use in administering specific programs and processes related to medical expense and utilization.
  • Creates comparative views of unit cost information that Market and Shared Service contracting teams can utilize to identify outlier contracts.
  • Conducts ongoing monitoring of medical cost savings initiatives.
  • Supports the business units to identify trend outliers, analyze the trend drivers and perform the work necessary to facilitate the discussion on possible solutions.
  • Performs detailed analyses, including accumulation of data, financial modeling, and reporting of outcomes.
  • Provides detailed analytics to provider network contracting teams in support of the negotiation process.
  • Develops ad hoc views of data that illustrates underlying trend issues for both cost and utilization.
  • Performs additional duties as assigned.
Additional Responsibilities:

Candidate Education:

  • Required A Bachelor's Degree in
Candidate Experience:
  • Required No Experience with a Bachelors Degree in Information Systems/Management, Computer/Data Science, Statistics, Mathematics, Informatics, Business, Economics or a closely related analytical field - OR -
  • Required 2 years of experience in Financial /Data Analysis with a Bachelors Degree in any other field of study
Candidate Skills:
  • Intermediate Ability to identify basic problems and procedural irregularities, collect data, establish facts, and draw valid conclusions
  • Intermediate Ability to work in a fast paced environment with changing priorities
  • Intermediate Demonstrated organizational skills
  • Intermediate Other Ability to interpret an extensive variety of technical instructions
  • Intermediate Other Ability to remain calm under pressure
  • Intermediate Ability to effectively present information and respond to questions from peers and management
Licenses and Certifications:
A license in one of the following is required:
Technical Skills:
  • Required Intermediate Microsoft Word
  • Required Intermediate Microsoft Outlook
  • Required Intermediate Microsoft Excel
  • Preferred Intermediate Other Knowledge of relational database concepts and designs
  • Preferred Intermediate Other SAS / SQL or similar database querying tool
  • Preferred Intermediate Other Healthcare data and systems

About us
Headquartered in Tampa, Fla., WellCare Health Plans, Inc. (NYSE: WCG) focuses primarily on providing government-sponsored managed care services to families, children, seniors and individuals with complex medical needs primarily through Medicaid, Medicare Advantage and Medicare Prescription Drug Plans, as well as individuals in the Health Insurance Marketplace. WellCare serves approximately 5.5 million members nationwide as of September 30, 2018. WellCare is a Fortune 500 company that employs nearly 12,000 associates across the country and was ranked a "World's Most Admired Company" in 2018 by Fortune magazine. For more information about WellCare, please visit the company's website at EOE: All qualified applicants shall receive consideration for employment without regard to race, color, religion, creed, age, sex, pregnancy, veteran status, marital status, sexual orientation, gender identity or expression, national origin, ancestry, disability, genetic information, childbirth or related medical condition or other legally protected basis protected by applicable federal or state law except where a bona fide occupational qualification applies. Comprehensive Health Management, Inc. is an equal opportunity employer, M/F/D/V/SO.



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