It’s an exciting time to join the WellSense Health Plan, a growing regional health insurance company with a 25-year history of providing health insurance that works for our members, no matter their circumstances.

The Senior Medical Economics Analyst is a key member of the Finance management team and serves as a strategic partner to various functional areas throughout the organization to meet corporate objectives. This includes the planning, development and building of analytical tools and to assess and manage provider and network performance, utilization management initiatives, value based and alternative payment arrangements, claims repricing and other key analytical exercises.

Our Investment in You:

• Full-time remote work
• Competitive salaries
• Excellent benefits

Key Functions/Responsibilities:

• Develop standard and ad-hoc reporting and analysis for provider collaboration agreements that will drive to strong provider relationships, reduced medical costs with improved quality outcomes and plan financials
• Use SAS and/or SQL to extract and analyze membership, claims and other healthcare data to support advanced healthcare analytics
• Supports the development and evolution of WellSense’s value based and alternative payment model strategy
• Measures, monitors, and communicates provider settlements related to APM and other payment arrangements
• Prepare sophisticated financial analysis of proposed value base contracting initiatives including the valuation of counter-proposals as well as analytics to support provider negotiations and contract renewal
• Identify favorable and unfavorable performance trends within medical cost initiatives; communicate trends to leadership with insights on trend drivers
• Build and enhance dashboard and analytics capabilities, including monthly tracking reports, analysis and scorecards, and key performance metrics
• Analyze hospital performance over time by re-pricing hospital inpatient and outpatient claims according to the base rates and factors published by State of MA
• Leads the development and ongoing maintenance of MA or NH regulatory and contractually required submissions
• Identifies deficiencies in data-quality and works cross functionally to resolve
• Advises Finance department on data warehouse redesign requests and works with IT to establish priorities
• Coordinate and participate in research-related activities including industry best-practices, research and development of models, tools, and data analysis projects, and experience studies
• Performs other related projects and duties as assigned

Qualifications:

Education:

• Bachelor’s Degree in Finance, Health Care Administration, Public Health or related field required
• Master’s Degree in a related field preferred

Experience:

• Five or more years of progressively responsible experience in managed care data analysis and reporting is required
• Three or more years conducting advanced analytics using SAS and/or SQL
• A background in managed healthcare, insurance operations required

Competencies, Skills, and Attributes:

• Advanced SAS programming skills in Base SAS, Macro and SAS SQL
• Strong analytical and problem solving abilities
• Ability to use all relevant data to support decision making
• Enjoy analytical challenges in a fast paced environment with strong ability for managing multiple projects simultaneously and meeting deadlines
• Project management skills a plus
• Strong communications skills, both verbal and written, are required

About WellSense

WellSense Health Plan is a nonprofit health insurance company serving more than 740,000 members across Massachusetts and New Hampshire through Medicare, Individual and Family, and Medicaid plans. Founded in 1997, WellSense provides high-quality health plans and services that work for our members, no matter their circumstances.

• WellSense will require proof of COVID-19 vaccination(s) as a term of employment for all employees. The company may make exceptions to this requirement in certain limited circumstances for religious or medical purposes.