Medical Economics Consultant - Medicaid Segment C2V
Job Title: Medical Economics Consultant - Medicaid Segment C2V Location: Pittsburgh, PA 15222, PAPenn Avenue Place Company: Highmark Inc.
Job Summary:
This job is responsible for using medical cost analytics to provide fact-based strategic insights into emerging medical cost trends. Using large sets of data, the ideal candidate will create the story of medical cost trends in a way that is clear, concise, and easily understandable. The incumbent will have proven detailed technical and analytical experience with strong communication and influencing skills.
Essential Responsibilities:
• Provide strategic and tactical insights into emerging medical cost trends. • Develop executive-ready presentations explaining analytical findings in a clear and concise manner. • Proficiency to extract, summarize, and analyze large datasets via SAS, SQL, or other similar tools. • Provide business areas with opportunity assessments of their strategic medical cost programs. • Coordinate savings opportunity projections and post-implementation savings measurements. • Develop improved business case and savings estimate capabilities to enable more accurate and deeper projections.
Leverage analytical experience and knowledge to drive independent medical cost analytics, develop areas of opportunity using a fact-based analysis, present medical cost analytics and insight into claim cost drivers to key business partners.
Strong communication skills, verbal and executive-quality presentations to present clear and concise presentations of the detailed analytics.
Work in a matrixed work environment. Partner with other departments in developing the full analytical story.
Other duties as assigned or requested.
Education:
• Required: Bachelors Degree in Business, Health Economics, Mathematics, Actuarial Sciences, or other related area. • Substitutions: None. • Preferred: Masters Degree in Business, Health Economics, Mathematics, Actuarial Sciences, or other related area.
Experience:
• Required: 5 years of Medical Economics, Healthcare Analytics, Informatics, and/or Actuarial Services in the healthcare payer sector. • Preferred: None.
Licenses and Certifications:
• Required: None. • Preferred: None.
Skills:
• Proven analytical ability to drive independent work and meet business timelines and outcomes. • Strong technical data skills: SAS, SQL, R, Tableau, Excel, etc. • Demonstrated ability to work with business partners in communicating outcomes, partnering on analytics, and developing new approaches to breaking down a strategic hypothesis. • Experience in the healthcare industry with solid knowledge of emerging trends and challenges. • Languages: Other than English, None. • Travel Required: 0 - 25%.
Physical and Mental Demands and Working Conditions:
• Position Type: Office-Based. • Teaches and trains others regularly. • Occasionally travel regularly from the office to various work sites or from site-to-site. • Rarely works primarily out-of-the-office selling products/services to employees. • Never physical work site required. • Lifting up to 10 pounds: Constantly. • Lifting 10 to 25 pounds: Rarely. • Lifting 25 to 50 pounds: Never.
Disclaimer:
The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job.
Compliance Requirement:
This position adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies.
Accessibility:
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Copyright:
2025 Highmark Health. All Rights Reserved.
Highmark provides millions of people with the security of quality health insurance
Our history of helping families and companies with their health insurance needs dates to the 1930s, when our predecessor companies were established to help Pennsylvania's residents pay for health care.
Highmark was created in 1996 by the consolidation of two Pennsylvania licensees of the Blue Cross and Blue Shield Association — Pennsylvania Blue Shield (now Highmark Blue Shield) and Blue Cross of Western Pennsylvania (now Highmark Blue Cross Blue Shield). We are now one of the largest health insurers in the United States.
Highmark's officers and board of directors set the company's strategic direction and corporate policies. They are guided by our mission, vision and values.