Mgr, Medical Economics

Horizon Blue Cross Blue Shield of New Jersey empowers our members to achieve their best health. For over 90 years, we have been New Jersey’s health solutions leader driving innovations that improve health care quality, affordability, and member experience. Our members are our neighbors, our friends, and our families. It is this understanding that drives us to better serve and care for the 3.5 million people who place their trust in us. We pride ourselves on our best-in-class employees and strive to maintain an innovative and inclusive environment that allows them to thrive. When our employees bring their best and succeed, the Company succeeds.

About The Role

Provides support and consultation to the Health and Network Solutions (HNS) through analyzing key business issues related to cost, utilization and revenue for all products at Horizon BCBS. Design and develop reports to monitor and identify the root causes of Medical and Provider cost trends. Collaborate with cross functional teams to identify opportunities to help bend the medical cost curve. Identify opportunities to reduce manual processes and interventions and develop systemic solutions to drive efficiency.

What You'll Do

• Develops analytics to develop evaluate the performance of medical and provider cost activities across Health and Network Solutions (HNS) and consults with business leaders on observations and recommendations.
• Identifies favorable and unfavorable trends, and develops recommendations to improve trends, communicate recommendations to management and analyzes the financial performance of all Horizon BCBS products, including Commercial, Medicare, and Medicaid.
• In partnership with the director directs the development and implementation of advanced analytic tools and techniques to identify cost drivers and ways to improve medical and provider cost performance.
• Expands the evaluation of provider performance evaluating and benchmarking providers across multiple cost of care categories and provide input and recommendations to contracting teams in order to guide contract negotiations, network strategy, and overall enterprise understanding of provider performance.
• Partners with the director and collaborates with finance and actuarial teams, to connect medical and provider cost activities to the enterprise processes including forecasting, budgeting, and pricing.
• Supports the director in maintaining effective internal controls over the processes and transactions under areas of responsibility including the completeness and accuracy of financial information and transactions, compliance with applicable laws and regulations, and the effectiveness and efficiency of operations.
• Identifies opportunities to reduce manual processes and interventions and develop systemic solutions to drive efficiency.
• Manage, develop and train staff; develop and monitor goals; conduct annual performance reviews, and administers staff salaries.
  
  

Education/Experience

What You Bring

• High School Diploma/GED required.
• Bachelor degree in math, statistics, actuarial, finance, accounting, economics, business administration or a related field preferred or relevant experience in lieu of degree.
• Requires minimum of 5 years of experience in developing complex financial models in order to drive analyses that will support business decisions.
• Requires minimum of 3 years experience Advanced SAS and/or SQL experience where you have created queries, pulled large data sets and performed data manipulations/analysis.
• Requires a minimum of 5 years of experience in health care/managed care with direct responsibility within a Financial Planning & Analysis (FP&A) and/or Medical Cost Management & Analysis discipline.
• Requires demonstrated experienced with leading big projects with cross-functional department at various levels
  
  

Knowledge

• Requires knowledge of Government Program, Commercial, Medicare market sectors and products. Communicate complex concepts to non-technical audience in digestible manner using data visualization.
• Knowledge of healthcare financial terms such as cost, utilization, Per Member Per Month (PMPM) and revenue.
• Advance knowledge with Excel: Work experience with MS Excel functions that include working with large data sets, creating standardized reports, utilizing vLookups and advanced functions/formulas; creating, using and interpreting pivot tables, filtering and formatting.
• Requires a demonstrated aptitude for analytical thinking and the ability to report findings in an accurate manner.
• Requires a demonstrated progressive understanding of managed care business processes, data, systems, and applications for claims payment, enrollment, benefit design, product pricing, network and provider contracting, and utilization management.
  
  

Skills And Abilities

• Strong problem solving and analytical skills; experience with relational database and techniques
  
  

Travel

• Minimal travel required.
  
  

Why Horizon?

At Horizon, you’ll do meaningful work that directly improves lives—while being supported by a mission‑driven organization that values expertise, collaboration, and growth. We believe that when our people thrive, our communities do too. If you are passionate about making an impact, we’d love to hear from you!

Salary Range

$109,600 - $149,625

This compensation range is specific to the job level and takes into account the wide range of factors that are considered in making compensation decisions, including but not limited to: education, experience, licensure, certifications, geographic location, and internal equity. This range has been created in good faith based on information known to Horizon at the time of posting. Compensation decisions are dependent on the circumstances of each case. Horizon also provides a comprehensive compensation and benefits package which includes:

• Comprehensive health benefits (Medical/Dental/Vision)
• Retirement Plans
• Generous PTO
• Incentive Plans
• Wellness Programs
• Paid Volunteer Time Off
• Tuition Reimbursement
  
  

Disclaimer

Horizon BCBSNJ employees must live in New Jersey, New York, Pennsylvania, Connecticut or Delaware. This job summary has been designed to indicate the general nature and level of work performed by colleagues within this classification. It is not designed to contain or be interpreted as a comprehensive inventory of all duties, responsibilities, and qualifications required of colleagues assigned to this job.

Horizon Blue Cross Blue Shield of New Jersey is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or status as an individual with a disability and any other protected class as required by federal, state or local law. Horizon will consider reasonable accommodation requests as part of the recruiting and hiring process.