Business Information Consultant - Provider Economics

Anticipated End Date:

Position Title:

Job Description:

Business Information
-Consultant - Provider Economics

This role requires associates to be in-office 1-2 days per week, fostering collaboration and connectivity, while providing flexibility to support productivity and work-life balance. This approach combines structured office engagement with the autonomy of virtual work, promoting a dynamic and adaptable workplace. Alternate locations may be considered if candidates reside within a commuting distance from an office.

Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law.

The Business Information Consultant - Provider Economics is responsible for generating and validating affinity, attribution, and membership and population segmentation. Identify and stratify members into Affinity, Attribution, Care Management, VBC Program membership and Market benchmark populations based on member preference, visit patterns, clinical criteria, geography, product, LOB and other member segmentation levers.

Assigns members to primary and/or specialty providers based on observed care patterns or declared relationships (provider affinity), and simultaneously evaluates whether those members meet clinical, demographic, and product-based criteria to be considered for participation in Carelon-led clinical interventions and/or risk-bearing programs. From the qualified target population, assigns members to specific risk arrangements and defines both target and performance benchmarks to determine their eligibility for care management, shared savings and other incentives.

Serve as an expert in data analysis, reporting and formulating recommendations and providing guidance to other data analysts.

• Creates and maintains databases to track business performance.
• Analyzes data and summarizes performance using summary statistical procedures.
• Develops and analyzes business performance reports (e.g. for claims data, provider data, utilization data) and provides notations of performance deviations and anomalies.
• Creates and publishes periodic reports, as well as any necessary ad hoc reports.
• May require taking business issue and devising best way to develop appropriate diagnostic and/or tracking data that will translate business requirements into usable decision support tools.
• May make recommendations based upon data analysis.
• Provides analytic consultation to other business areas, leadership or external customers. Data analysis and reporting encompasses a much higher level of complexity.

Requires a BS/BA degree in related field and a minimum of 5 years experience; or any combination of education and experience which would provide an equivalent background.

• Experience with relational databases and knowledge of query tools and statistical software preferred.
• Ability to manipulate large sets of data strongly preferred.
• Strong analytical, organizational, presentation, and problem solving skills strongly preferred.
• Strong analytical and technical skills, including proficiency in SAS, SQL, Snowflake, or similar data manipulation tools preferred.
• Strong communication skills to present clear, concise presentations of the detailed analytics preferred.
• Documentation of assumptions and technical requirements, and developing clear, concise presentations for both technical and non-technical audiences preferred.
• Experience providing leadership in evaluating financial performance of complex organizations preferred.
• BA/BS degree in Actuarial Sciences or Health Economics preferred.
• Minimum of 5 years in healthcare industry in medical economics, provider finance, healthcare analytics, or actuarial services preferred.

Non-Management Exempt

RDA >
Business/Health Info

Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.

Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.

At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our…