We are excited to expand our team and looking for a seasoned healthcare analytics professional with prior Medical Economics experience, preferably from a major healthcare insurer. This is NOT an IT/Data architecture role and is focused on leveraging current analytical tools to interpret and disseminate complex claims and provider contracting data.
Are you a seasoned Medical Economics professional exploring next steps in your field? Have you been part of amazing teams resulting in explosive industry knowledge and analytical skill sets and feel driven to share your talents to make a real impact? Curative is a young organization stacked with seasoned industry leaders and top-tier talent who are excited to share and grow our simplified, $0 copay/$0 deductible (yes, really!) employer-sponsored commercial healthcare movement based on affordability and engagement.
As the Senior Medical Economics Analytics Consultant specializing in competitive rate intelligence/provider contract analytics, you will work alongside the Director of Medical Economics on the Network Development team and partner with Curative’s expert negotiators, tech, data analytics and financial teams to serve a mission-critical role providing curated market and impact data to our talented colleagues as they negotiate optimal contractual relationships with healthcare providers. You will experience the excitement and engagement of a highly supportive and collaborative start-up environment while seeing your industry experience and analytical contributions be valued and directly drive decisions!
Despite our youth, our data teams are mighty and you will have easy access to our well- structured and materialized claims data along with a suite of versatile querying and analytical tools to leverage. While the focus of this role is more weighted toward the business consumption side of healthcare data (competitive research, data querying/merging/transformation, contract analytics, consultative insight) vs the technical aspects (data architecture, stored procedures, dashboarding, tool/product development) your technical understanding of healthcare data inside relational databases and your passion for
financial modeling and translating complex data into a story will play a major role in developing best practices and tools local to the Network Development team.
Key Responsibilities:
- Leverage complex price transparency data (Clarify, machine files, websites, etc.) and existing or proxy claims data to curate competitive rate and utilization intelligence to equip the team with vital data-based support used in negotiation activity.
- Evaluate provider contracts, fee schedules and reimbursement arrangements to ensure alignment with organizational goals and identify opportunities for cost containment, revenue optimization and resource maximization.
- Develop and utilize financial models to assess the impact of contractual changes on costs, utilization patterns and overall financial performance.
- Conduct sensitivity analyses and scenario planning to evaluate different contract structures and reimbursement models to provide insights into performance, utilization patterns and cost drivers.
- Collaborate with actuarial and financial teams to forecast budgetary impacts and support strategic decision-making.
- Identify opportunities to expand or optimize provider networks based on market dynamics.
- Collaborate with the data analytics team to develop any additional dashboards or tools specific to the Network Development team for monitoring contract performance and supporting decision- making.
- Leverage and monitor complex price transparency data (like Clarify) and other resources to stay abreast of market rate intelligence, healthcare regulations, reimbursement policies and industry trends impacting provider contracts and financial arrangements.
- Ensure compliance with regulatory requirements and contractual obligations related to
reimbursement methodologies and payment integrity.
Required Qualifications:
- Bachelor’s degree in Economics, Healthcare Administration, Business, Math, Statistics, Finance or a related field.
- Minimum of 5 years of experience in medical economics with at least 3 years dedicated to contract analytics.
- Must be proficient in MS Excel (Power Pivot fundamentals and basic DAX measures a plus), understand healthcare data inside relational databases (e.g. SQL) and have creativity in data storytelling (e.g. Looker, Power Pivot, Power BI, Tableau).
- Strong understanding of healthcare contract analytics, general claim anatomy and industry groupings, claims adjudication, reimbursement methodologies and provider contracting strategies (commercial contracting experience strongly desired).
- Strategic-thinker and resourceful problem-solver with a strong commitment to help drive improved healthcare outcomes for our members.
- Strong project management skills with the ability to prioritize and manage multiple initiatives simultaneously, to work independently as well as in a highly-collaborative “start-up” environment.
- Remote with light travel (5-10%)
- At least 5 years of relevant commercial medical economics experience with at least 3 years analyzing contract negotiations.
- Experience with TX, FL and GA markets a plus!