Advisor, Medical Economics
Medicare AdvantagePricing & RatingBusiness Intelligence & ReportingPredictive Modelling & ML
Role Summary
Loading...HIGHLIGHTS
Health-focused medical economics role supporting Medicare Advantage analytics in Nashville, TN. You will analyze claims, membership, and utilization to forecast revenue using HCC/RAF methodology and provide actuarial support to Operations, Clinical, and Finance teams. The role requires strong Excel and PowerBI skills and 4+ years' experience with health plans, ACOs, RBEs, or consulting.
JOB DESCRIPTION SUMMARY
- Analyze healthcare cost drivers and utilization patterns for Medicare Advantage
- Provide actuarial support and revenue forecasting using HCCs and RAFs
- Work with Engineering to source data and build end-user reports
- Use Excel and Power BI for analysis and presentation; SQL experience preferred
- Associate-level role requiring 4+ years in health plan/ACO/RBE/consulting analytics
DOMAIN EXPERTISE
- Experience with health plans, ACOs, RBEs, or consulting focused on health economics
- Medicare Advantage actuarial support and profitability analysis
- Experience with HCCs and RAFs for revenue forecasting
- Claims, membership, and prior authorization data analysis
- Product trend analysis using statistically valid methodologies
KEY REQUIREMENTS
- Bachelor's degree in relevant quantitative field required
- 4+ years' analyst experience with health plans, ACOs, RBEs, or consulting
- Expertise in MS Excel including PivotTables and reporting
- Experience with HCCs and RAFs for Medicare Advantage revenue forecasting
TECH STACK
- Excel
- Power_BI
- PowerPoint
