Healthcare Economics Data Analyst

Healthcare Data Analyst

About Us

Common Ground Healthcare Cooperative is a "who" not a "what." As a cooperative, we are thousands of Wisconsin residents buying health insurance together, supported by a staff focused on providing the best possible service to our members. We are a not-for-profit cooperative, governed by a Board of Directors made up of members who purchase our health insurance. Any earnings are returned to our members in the form of lower prices and better services.

Our Culture

We are here because we can make a difference in the lives of others. We believe that serving our community is meaningful work and we hold it in the highest regard. We are vibrant, dynamic, and value-focused individuals who welcome different points of view, perspectives, and thoughtful solutions to challenges. We encourage teamwork, integrity, mutual respect, honesty and doing the right thing. We know the importance of showing appreciation for a job well done, celebrate our achievements, and make room for fun and laughter in the workplace.

Our Job

We are continuously improving our efforts to serve our members and lower their overall healthcare cost through our three key pillars: Advocacy Partnership Innovation.

Does this sound like a culture you'd like to be a part of?

Come join a fun team of committed professionals!

How You'll Make a Difference

The Healthcare Data Analyst is responsible for performing sophisticated quantitative analyses for maintaining, and improving, the overall financial health and performance of the company. These analyses will include risk-based capital forecasts; premium forecasting; financial performance by line of business, geographic area, and plan; budget forecasts; and claims analyses. The claims-focused analyses will include those that focus on fraud, waste, and abuse; claims inventory; and analyses that identify improved utilization, or provider contracting, approaches. The position will carry out analyses, and participate in decisions, regarding plan design, rate development, and creating financial models that will help the executive team to evaluate the ROI on new and different business propositions. This position will report to the Director of Actuarial Services and will make significant contributions to the development and achievement of the company's strategic planning portfolio. Strong collaboration with other departments within the company will be critical to the success of this position.

Utilize Your Skills By

• Designs and enhances medical and pharmacy claim utilization, membership, and revenue reporting.
• Combines data and information from multiple sources to analyze and draw conclusions about plan performance, including electronic health record, eligibility, or claims data.
• Collaborates on written narrative summaries that outline analytical project purposes, methodologies employed, summary of findings, trends of interest, and opportunities for consideration.
• Evaluates options and makes recommendations to business processes across the health plan to gain efficiencies and enhance performance.
• Formulates data-based recommendations and effectively communicates them throughout the organization, providing explanations, information, and direction to business leaders regarding trends and forecasts.
• Supports, and enhances, both internal and external reporting around key financial metrics.
• Conceptualizes and creates ad-hoc analyses, projects, and reports to assist in making appropriate business decisions and improvements.
• Analyzes key trends and performance related to clinical programs, provider network performance, other programs or practices, and providers of health care.
• Converts data-centered findings into recommended solutions, changes to business practices, and/or new opportunities.
• Collaborates with leaders across the plan to identify opportunities for improvement and best use of resources, anticipating business needs and proactively developing ideas and solutions to meet them.
• Develops new reports, tables, dashboards, and charts as needed, and assists with the maintenance of existing reports.
• Works on special projects as requested and all other duties as assigned.
• Presents analytic trends and recommendations to all levels of the plan, including the ability to report findings to senior leadership.
• Creates and provides sound statistical analyses and frame business scenarios that are meaningful and have impact on critical business processes and/or decisions.
• Collects, analyzes, interprets, and presents comparative clinical and cost data, integrates benchmark information, and uses findings as a foundation for intervention and improvement.
• Designs, develops, and continuously improves new and existing forecasting models and tools.

What You'll Need To Bring

• Understanding of basic actuarial concepts, e.g., per member per month calculations.
• Ability to handle multiple analysis projects simultaneously.
• Bachelor's Degree in statistics, mathematics, finance, accounting, or related field.
• Experience assembling complex financial forecasts and projections, based on differing underlying assumptions.
• High comfort level in working closely with actuaries, accountants, and other analysts.
• Ability to participate in strategic decision-making discussions.
• Advanced analytical skill set, including Excel skills is required, SQL programming is desired.
• Experience integrating data sets from different sources and in different formats.
• Experience working in a rapid cycle, decision support role, and very dynamic environment.
• Ability to assist with, or support, risk adjustment systems and operations.
• Ability to maintain confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA).
• Ability to conceptualize, structure, perform, and interpret "what if?" Scenarios.

General Requirements

• Ability to be flexible and adapt to changing situations.
• Ability to communicate effectively in-person and in all forms of communication, strong presentation skills.
• Excellent verbal and written communications skills, as well as excellent interpersonal skills to help maintain strong relationships and work with senior-level management.
• Ability to treat others with dignity, respect, and courtesy.
• Ability to work independently and be self-directed in completion of responsibilities.
• Adheres to Company policies and procedures.
• Ability to work in a team environment.
• Attendance according to Company standards.
• Proven service orientation with attention to detail and follow-up.
• Ability to maintain patient, employee, and proprietary confidentiality.
• Ability to provide professional image and act professionally.

We've Got You Covered

CGHC offers a comprehensive benefit package and broad range of programs to meet the needs of our employees to help protect your health, wealth, and future.

Job Posted by ApplicantPro