Published: Wed, 03 Sep 2025 00:50:39 GMT
Position: Senior Medical Economics Analyst
Job Summary:
The Senior Medical Economics Analyst is a vital member of the Health Plan and Finance team at Molina Healthcare. This position is responsible for providing support and consultation by analyzing key business issues related to cost, utilization, and revenue for multiple Molina Healthcare products. The Senior Medical Economics Analyst will design and develop reports to monitor health plan performance and identify root causes of medical cost trends. This role is also responsible for driving innovation by creating tools to monitor trend drivers and providing recommendations to senior leaders for affordability opportunities.
Key Responsibilities:
– Extract and compile information from various systems to support executive decision-making
– Mine and manage information from large data sources
– Analyze claims and other data sources to identify early signs of trends or other issues related to medical care costs
– Work with clinical, provider network, and other personnel to bring supplemental context/insight to data analyses
– Design and perform studies related to the quantification of medical interventions
– Track key performance indicators of medical interventions with business owners
– Conduct pro forma sensitivity analyses to estimate the expected financial value of proposed medical cost improvement initiatives
– Proactively identify and investigate complex suspect areas regarding medical cost issues
– Initiate in-depth analysis of suspect/problem areas and suggest corrective action plans
– Draw actionable conclusions based on analyses performed and make recommendations through the use of healthcare analytics and predictive modeling
– Communicate conclusions effectively to audiences at various levels of the enterprise
– Analyze the financial performance of all Molina Healthcare products
– Identify favorable and unfavorable trends and develop recommendations to improve trends
– Communicate recommendations to management
– Lead projects to completion by contributing to ad-hoc data analyses and developing and presenting financial reports
– Serve as a subject matter expert on developing financial models to evaluate the impact of provider reimbursement changes
– Provide data-driven analytics to Finance, Claims, Medical Management, Network, and other departments to enable critical decision-making
– Support Financial Analysis projects related to medical cost reduction initiatives
– Assist Medical Management with Return on Investment (ROI) analyses for vendors to determine if their financial and clinical performance is achieving desired results
– Keep abreast of Medicaid and Medicare reforms and their impact on Molina Healthcare
Job Qualifications:
Required Education:
– Bachelor’s Degree in Mathematics, Economics, Computer Science, Healthcare Management, or related field
Required Experience, Knowledge, Skills, and Abilities:
– 5+ years of related experience in healthcare
– Demonstrated understanding of Medicaid and Medicare programs or other healthcare plans
– Analytical work experience within the healthcare industry (i.e., hospitals, network, ancillary, medical facilities, healthcare vendor, commercial health insurance company, large physician practices, managed care organization, etc.)
– Proficiency with Microsoft Excel (formulas, PIVOT tables, PowerQuery, etc.)
– Proficiency with Excel and SQL for retrieving specified information from data sources
– Experience with building dashboards in Excel, Power BI, and/or Tableau and data management
– Knowledge of healthcare operations (utilization management, disease management, HEDIS quality measures, claims processing, etc.)
– Knowledge of healthcare financial terms (e.g., PMPM, revenue) and different standard code systems (ICD-10CM, CPT, HCPCS, NDC, etc.) utilized in medical coding/billing (UB04/1500 form)
– Demonstrated understanding of key managed care concepts and provider reimbursement principles such as risk adjustment, capitation, FFS (Fee-for-Service), Diagnosis Related Groups (DRG’s), Ambulatory Patient Groups (APG’s), Ambulatory Payment Classifications (APC’s), and other payment mechanisms
– Understanding of value-based risk arrangements
– Experience in quantifying, measuring, and analyzing financial, operational, and/or utilization metrics in healthcare
– Ability to mine and manage information from large data sources
Preferred Qualifications:
– Proficiency with Power BI and/or Tableau for building dashboards
– Experience with Databricks and TOAD Data Point
To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V. Apply link