Medical Economics Analyst

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.

About the role

The Medical Economics Analyst provides support and consultation to the Medical Economics team through analyzing key business issues related to cost, utilization and revenue for all products at Horizon BCBS. You will design and develop reports to monitor product performance and identify the root causes of medical cost trends. With those root causes identified, you will drive innovation by creating tools to monitor trend drivers and provide recommendations to bend the cost curve. You will also create financial models to evaluate financial impact related to changes in healthcare management programs or provider contract changes.

What you'll do

• Works within Health and Network Solutions to analyze the financial performance of all Horizon BCBS products, including Commercial, Medicare, and Medicaid, identifying favorable and unfavorable trends, and develop recommendations to improve trends, communicate recommendations to management.
• Develop insights and recommendations based on your work and deliver executive level presentations to educate and build support for needed changes
• Perform drilldown analysis into claims trend to identify actionable items focusing on cost and utilization measures across member and provider demographics and cost categories
• Provide data driven analytics to various teams including Medical Management, Network, and other departments to enable critical decision making.
• Support Financial Analysis projects related to medical and provider cost reduction initiatives.
• Lead projects to completion by contributing to ad-hoc data analyses, development, and presentation of financial reports.
• Serve as subject matter expert on developing financial models to evaluate the impact of provider reimbursement changes, including contract changes with hospital, ancillary and physicians.
• Develop reports that analyze cost trends on provider level and communicate recommendations to HNS teams including Network Contracting and Care Management
• Develop, maintain, and automate your own reporting from available data sources using a combination of analytical and financial analysis techniques
• Leads the Healthcare Management Reporting process (partnering with analytics and actuarial) aimed at the presenting and understanding P&L performance including, but not limited to
• (i) Variance Analysis/Commentary - Actual vs Budget/Plan and Prior Year
• (ii) Revenue detail and components
• (iii) Medical Cost detail and trend drivers
• (iv) Performance of Medical Cost Action Plans
• (v) Product Mix
• (vi) Market Segment financial results. Includes accountability for leading projects and initiatives to drive performance and enterprise-wide interfacing with business leaders and subject matter experts.

What you bring

Education/Experience

• High School Diploma/GED required.
• Bachelor degree in accounting or finance preferred or relevant experience in lieu of degree.
• Requires a minimum of 3-5 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 a 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.
• Experience working closely with business partners such as Analytics, Actuaries and/or FP&A in order to develop solid skillsets with the following disciplines: medical cost analysis, market segment premium development, monthly financial reporting and variance analysis, annual business plan/budget development and presentations to management.
• Experience in Medical Cost Management & Analysis or other financial planning and analysis work preferred
• Experience in developing complex financial models and reporting to drive analyses that will support business decisions preferred.

Knowledge

• Analytical work experience within the healthcare industry highly preferred (i.e. hospitals, network, ancillary, medical facilities, healthcare vendor, commercial health insurance company, large physician practices, managed care organization, etc.)
• Work experience with SAS and/or SQL where you have created queries, pulled large data sets and performed data manipulations/analysis highly preferred
• Advance knowledge with Excel highly preferred: Work experience with MS Excel functions that include working with large data sets, creating standardized reports, utilizing vLookups and advanced functions/formulas; creating, using and interpreting pivot tables, filtering and formatting
• Requires solid understanding of P&L management principals, actual versus budget variance analysis, and general knowledge of budgeting and planning principals.
• 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.

Skills and Abilities

• Requires proven quantitative and financial analysis skills.
• 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 process mapping capabilities in order to develop new methodologies to achieve a desired end result.
• Requires the ability to work independently with minimal direct supervision and exercise sound business judgment.
• Requires direct knowledge, or the ability to learn quickly Horizons Accounting and Financial Planning & Analysis (FP&A) platforms (ex. Lawson General Ledger system, Hyperion Planning).
• Requires advance knowledge of Excel.
• Requires experience with Word and PowerPoint.
• Requires technical skills with database concepts, data analysis development, data warehousing, and data extraction tools (ex. SQL).

Why Horizon?

At Horizon, you’ll do meaningful work that directly improves lives—while being supported by a mission‑driven organization that values expertise, collaboration, and growth. We believe that when our people thrive, our communities do too. If you are passionate about making an impact, we’d love to hear from you!

Salary Range

$87,300 - $119,070

​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

Disclaimer

Horizon BCBSNJ employees must live in New Jersey, New York, Pennsylvania, Connecticut or Delaware. This job summary has been designed to indicate the general nature and level of work performed by colleagues within this classification. It is not designed to contain or be interpreted as a comprehensive inventory of all duties, responsibilities, and qualifications required of colleagues assigned to this job.

Horizon Blue Cross Blue Shield of New Jersey is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or status as an individual with a disability and any other protected class as required by federal, state or local law. Horizon will consider reasonable accommodation requests as part of the recruiting and hiring process.