Cost of Care Analyst

Overview

Location: 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.

The Cost of Care Analyst (Advanced Analytics Consultant) employs advanced analytics to gain critical insights into member behavior drivers and preferences, product/program concepts and value propositions, operational effectiveness, and efficiencies, and client-specific health gaps and needs. Consults business leaders and internal partners to apply the insights to test and drive product innovation and enhancement, to target the right members for the right service, measure program outcomes and demonstrate value, help win and retain clients, and support information-based strategic decision-making.

• Provides analytical insights to support business solution development based on quality, use, cost, and other key drivers.
• Develops and refines analysis templates for problem diagnosis and opportunities assessment.
• Consults on all considerations related to designing and executing tests or pilot programs.
• Contributes to the design of new programs/initiatives based on test/pilot outcomes.
• Develops targeting criteria or customer segmentation based on analytical insights, clinical inputs, product design, and operations considerations.
• Develops predictive models and other tools that help target the right members.
• Develops methodology to measure clinical, utilization, and financial outcomes of a program/initiative.
• Conducts in-depth research to address challenging issues in measuring outcomes.
• Leads applied research projects.
• Authors white papers, presents at industry conferences, and submits journal publications.
• Addresses the limitation of certain data sources and evaluates the incremental value of new data sources.

• Requires MS, MA, or PhD with concentration in a quantitative discipline such as Mathematics, Statistics, Economics, Epidemiology, Engineering, Computer Science or Operations Research and a minimum of 5 years experience in related health care analytics; or any combination of education and experience which would provide an equivalent background.

• Experience performing trend analysis to identify patterns in healthcare costs over time, offering insights to optimize cost management strategies and improve financial outcomes preferred.
• In-depth understanding of healthcare dynamics, including service delivery, reimbursement models, and payer systems preferred.
• Experience in healthcare finance or healthcare actuarial analytics preferred.
• Substantial analytical experience in the healthcare industry preferred.
• Advanced SQL & SAS skills.
• Oracle Exadata experience preferred.
• Familiarity with AI/ML frameworks.
• Additional skills for success are Python, Informatica, Tableau, and/or Power BI.
• Experience in using Agile estimation techniques such as Planning Poker, T-shirt Sizing, or the Fibonacci sequence to provide relative estimates related to Cost of Care.
• The ability to present meaningful results to a business audience, to participate collaboratively in a team tasked to produce complex analyses on a rigorous schedule, and to communicate with strong written and verbal communication skills.
• Comprehensive experience with Teradata, SQL, or equivalent data databases strongly preferred.

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…