Lead Health Economics Analyst

Leads the compilation, analysis, and interpretation of healthcare clinical and utilization data to produce insights related to cost drivers and opportunities to improve affordability and clinical outcomes for current and prospective VNS Health members. Owns the end-to-end analytic approach for monitoring membership, medical expenses, utilization, and revenue trends; conducts advanced forensic investigations into anomalies and unfavorable trends; and develops executive-ready presentations, dashboards, and supporting documentation to inform strategic and operational decisions. Partners cross-functionally to translate findings into measurable interventions, including medical expense management, payment policy, utilization management, clinical initiatives, affordability, and value-based payment arrangements. Works under general supervision.

What We Provide

• Referral bonus opportunities
• Generous paid time off (PTO), starting at 30 days of paid time offand 9 company holidays
• Health insurance plan for you and your loved ones, Medical, Dental, Vision, Life and Disability
• Employer-matched retirement saving funds
• Personal and financial wellness programs
• Pre-tax flexible spending accounts (FSAs) for healthcare and dependent care
• Generous tuition reimbursement for qualifying degrees
• Opportunities for professional growth and career advancement
• Internal mobility, generous tuition reimbursement, CEU credits, and advancement opportunities

What You Will Do

• Leads monitoring of medical expense and utilization trends on a regular basis and performs ongoing forensic analyses to uncover underlying patterns in member utilization, data anomalies and operational inefficiencies.
• Develops executive ready presentations and translates complex analyses into clear and actionable business insights through effective use of clear visualizations and storytelling.
• Synthesizes complex findings into clear narratives and decision-ready recommendations.
• Serves as the Health Economics team's representative in leadership and cross-functional forums by presenting findings and recommendations; influence solution adoption and monitor post-implementation outcomes.
• Builds and maintains analytic tools and dashboards to monitor trends in medical costs and utilization KPIs and intervention performance.
• Develops and governs scalable analytic data structures and pipelines used by the Health Economics Team; establishes documentation, data governance and data quality standards across acquisition, normalization, and transformation.
• Partners with Finance and product leadership to evaluate affordability across membership panels, settings of care, and clinical programs.
• Represents the Health Economics Team and interacts cross-functionally with a wide variety of teams, including end-users, to ensure that analyses are serving business needs.
• Leads analytic planning with Data Science and related partners; documents statistical design/methodology and ensures appropriate interpretation of results, limitations, and sensitivity analyses.
• Provides coaching, technical guidance, and quality review for junior analysts; may lead project teams and coordinate work across analysts and stakeholders.
• Supports execution of large-scale projects with moderate direction from leadership.
• Participates in special projects and performs other duties as assigned.

Education:
Master's Degree in Data Analytics, Statistics, Biostatistics, Mathematics, Data Science, Econometrics, Epidemiology, Health Administration or other related degree required

Work Experience:

• Minimum of six years of progressive experience in data analytics in a healthcare setting required
• Demonstrated ability to apply statistical methods to complex data, draw defensible conclusions, and make recommendations that drive measurable business impact required
• Advanced proficiency with statistical software (e.g. R, Python, SAS) required
• Effective oral, written, and interpersonal communication skills required
• Experience with relational databases and programming experience in SQL required
• Experience in a managed care organization (e.g. Medicare Advantage, Managed Long-Term Care (MLTC), Mainstream Medicaid Managed Care) preferred
• Experience with business intelligence applications (e.g. MicroStrategy or Tableu) or dashboarding frameworks (e.g. R-Shiny, DASH) and communicating insights through data visualization and storytelling preferred
• Experience with medical claims and health assessment data (e.g. OASIS, UAS-NY, Medicare Health Risk Assessment (HRA)) preferred
• Knowledge of Medicare and NYS Medicaid payment policy and alternative payment models (e.g. BPCI, PDGM Value Based Payments, dual-risk models, Hospice Final Rule) preferred
• Knowledge of Medicare and NYS Medicaid and coding experience with DRG, ICD10, HCPCS and CPT4 preferred