Reports To: SVP, Healthcare Management
Manages : Department of medical economists, actuarial and other analysts
Purpose: This position provides critical support to the SVP, Healthcare Management and other members of the Senior Leadership team in their development of strategies to achieve key corporate goals. Among other duties, this position is responsible for the development and clear presentation of various statistical data, and by thoroughly analyzing this historical information, predicting future results in profitability, enrollment, medical utilization and cost, and other significant areas. This position is responsible for the performance of detailed analytics which provide management with a sound understanding of actual results and the main drivers of such performance. This position is also responsible for the determination and production of key business metrics to support many areas. This position ensures that appropriate and consistent analysis is performed across all analytic teams, and that core work under reporting and analytics is aligned with the goal of improving product value and ensuring customer expectations are met or exceeded. This position translates business questions into appropriate statistical or analytical requirements, and directs others to resolve highly complex or unusual business problems that affect major functions or disciplines.
1. Hires, develops, manages and motivates a performance-based analytics team, providing ongoing direction, leadership, evaluation, training and development of staff to maximize return and drive results.
2. Conducts and coordinates cross-functional analysis of health care data to identify trends, explain plan results, and uncover and investigate problems and opportunities for plan improvement. Communicates findings to senior management and the appropriate stake-holders.
3. Responsible for the design, production and analysis of provider and member profile reports.
4. Responsible for the design, production, and analysis of detailed statistical reports regarding corporate profitability, with key findings highlighted and expert analysis of the reasons for such results presented clearly and concisely to enable appropriate management decisions to be made.
5. Responsible for the design, production, and analysis of corporate enrollment reports, with analysis of membership by product, geography, demographic strata, etc. ,
6. Analyzes and reports on business performance of brokers with respect to CCI products.
7. Provides expert actuarial analysis, insights, ideas, and data support for provider and vendor contractual agreements and risk or incentive arrangements, as well as contract negotiations.
8. Accountable for employer group reporting, performance analysis, and benchmarking, including large case reporting.
9. Supports the growth of ConnectiCare’s Medicare Program Management initiatives with quantitative management analysis including the STARS reporting and analysis.
10. Analyzes proposed medical management programs to project the cost and savings from such initiatives, thus supporting the efforts to achieve the company’s financial and membership goals.
11. Responsible for the development of accurate quarterly financial forecasts for the company, including all revenue and medical expense items, to enable successful pricing and other management decisions to be performed.
12. Responsible for the development of accurate medical expense trend projections for use in the development of customer premium rates.
13. Responsible for the development and performance of risk classification analysis of the company’s book of business and various segments of the enrolled membership to support pricing, underwriting, marketing, and sales strategies.
14. Responsible for ad hoc data mining, reporting, and analytic tasks to help various areas of the company achieve departmental or company goals.
15. Perform other related projects and duties as assigned.
TECHNICAL KNOWLEDGE, EXPERIENCE AND SKILL REQUIREMENTS:
1. Bachelor's Degree required, preferably in Mathematics/Actuarial Science/Finance/Economics or a related field.
2. At least 10 years of previous experience in medical economics or analytics required.
3. Strong analytical skills with solid foundation in mathematical and statistical techniques.
4. Excellent oral and written communication and interpersonal skills required.
5. Strong, independent decision-making ability and negotiation skills and prior success in leadership.
6. Ability to manage multiple priorities.
1. Leadership: Creates company image with business leaders and promotes the internal culture. Promotes, hires, and retains a talented and diverse workforce. Sets clear and obtainable objectives for employees. Delivers timely and specific feedback (both positive and negative) and is effective in delivering appropriate rewards and recognition. Sets high standards for self and others and demonstrates enthusiasm for the mission of the team.
2. Member and Customer Focus: Recognizes that members and customers (internal & external) are the driving force behind every business activity. Continuously makes an effort to exceed the expectations of members and customers.
3. Quality Orientation: Assumes responsibility for providing the highest level of quality to members and customers.
4. Innovation: The ability to see opportunities for change, to capitalize on them and implement them when appropriate for the benefit of ConnectiCare.
5. Communication: The ability to communicate with clarity both orally and in writing.
6. Teamwork: Demonstrates enthusiasm for the mission of ConnectiCare and inspires the same in others.
7. Results Orientation: The ability to break a complex problem down into its component parts and arrive at the appropriate solution in a timely fashion.
8. Change Mastery: Embraces change.
9. Learning Orientation: Assumes responsibility for personal and professional development.
ConnectiCare is an equal opportunity employer. M/F/D/V
ConnectiCare is one of the largest HMOs in Connecticut. In 1979 a group of doctors at Hartford Hospital planted the seeds for what would...