Manager Medical Economics & Business Process

Role Overview: The Manager, Medical Economics & Business Process leads a team responsible for delivering healthcare data and medical economics analyses across a variety of data sources, including claims, authorizations, member, and provider data. This role partners closely with cross‑functional teams to structure and execute analyses, generate insights, and identify opportunities to improve medical costs, operational performance, and overall business outcomes. This is a hands-on role, which combines team leadership with active analytic contributions to core workstreams.

Work Arrangement:

• Remote - This position is fully remote and may be performed from any location within the United States; however, the associate is required to work during Eastern Standard Time (EST) hours.

Responsibilities:

• Lead complex analyses addressing healthcare cost, utilization, and operational performance using internal and external data sources.
• Demonstrate a comprehensive understanding of key drivers of healthcare trends and effectively synthesize complex concepts for diverse audiences.
• Serve as a trusted advisor to business partners by translating medical costs and operational insights into strategic opportunities and recommendations.
• Mentor, develop, and lead a high‑performing analytics team focused on market‑level and enterprise healthcare financial and operational data.
• Collaborate and build strong relationships with cross‑functional partners to understand business questions and deliver actionable insights.
• Translate business needs into clear analytic requests and guide the development of appropriate methodologies.
• Design and develop innovative analytic solutions, tools, and approaches to address complex business problems.
• Work comfortably with large, complex, and diverse healthcare data sets to support decision-making and performance improvement.

Education & Experience:

• Bachelor’s degree in actuarial science, economics, computer science, or a related field required
• Master’s degree is preferred.
• 5 to 10 years of health plan analytics with in-depth analytics, technical expertise, and business knowledge
• 5 years of experience presenting analytical results.
• 5 years of experience in healthcare data analysis and information reporting. Facilitation, decision-making, organizational/business expertise, and analytical skills.
• 5 years of experience with SQL and Tableau/Power BI

Skills & Abilities:

• Strong understanding of Medicaid managed care, healthcare, and operational data.
• Advanced analytical and problem‑solving skills with the ability to address complex business questions.
• Advanced capabilities in pulling, validating, and synthesizing data to derive actionable insights for the organization.
• Excellent verbal and written communication skills, with the ability to clearly convey insights to technical and non‑technical audiences.
• Proven leadership and mentoring skills, with experience developing high‑performing analytic teams.
• Strong organizational skills and ability to manage multiple priorities in a fast‑paced environment.
• Ability to think strategically while maintaining attention to detail and data accuracy.