Manager - Health Economics & Provider Analytics

Job Overview

This role focuses on delivering specific analytical tasks to examine and validate statistical health data, aiming to uncover and quantify effects on medical cost trends. The ultimate goal is to ensure optimal healthcare quality and cost efficiency for members.

Healthcare Data Analysis

• Design integrated data models consolidating patient information from diverse sources to form comprehensive health data views.
• Segment members based on health risk and profile chronic conditions such as cancer, hepatic disease, renal failure to facilitate cost reduction and improve customer retention.
• Conduct studies to assess the feasibility and impact of proposed projects.
• Publish monthly provider reports highlighting key drivers, costly medications, and significant cases.

Business Opportunities

• Identify quantified business waste from atypical behaviors or irregular billing patterns.
• Detect and eliminate inefficiencies to produce actionable savings initiatives.
• Communicate savings opportunities emerging from recoveries or preventative measures and track provider cost inflation by medical condition and benefit.
• Measure actual savings impacts before and after cost management actions.

Data Management

• Utilize advanced service categorization with standardized and clear mappings.
• Manage the introduction and upkeep of enhanced segmentation for services and medical conditions.
• Validate and maintain accuracy of doctor names, specialties, and unify service coding processes.

Provider Commercial Terms

• Develop and review contractual terms with current and potential providers within the Bupa network.
• Create and enforce new pricing comparison templates and impact analyses, accounting for differing billing methods and service complexities.

Analysis Transformation

• Collaborate cross-functionally to implement Big Data projects, digital transformation, and analytics advances including machine learning models.
• Interpret and verify data inputs for incorporation into advanced analytics methodologies.

Provider Inflation Monitoring

• Track medical inflation metrics, maintaining vigilant oversight of factors influencing short- and long-term costs.
• Report on cost trend movements, ongoing operational initiatives, their progress, and highlight exceptions requiring action.

Qualifications and Skills

• 3 to 5 years of professional experience, ideally within healthcare or health insurance sectors.
• Proficient to advanced user of Microsoft Excel and PowerPoint.
• Skilled in analyzing healthcare claims data and manipulating datasets.
• Able to interpret both macroscopic and detailed data perspectives.
• Possession of a bachelor's degree; background in medical or related field preferred.