Health Plan Pricing and Analytics

3 weeks ago

Atlanta, United States Integrated Resources, Inc Full time

Job Title: Health Plan Pricing and Analytics

Job Location: Remote

Job duration: 6 Months (Possible to Extension)

Pay Rate - $45.00/hr. on w2

Important Notes:

Role is 100% remote working CST or EST hours. It would be a plus if candidates reside near St. Louis, MO or Morris Plains, NJ and are able to work hybrid

Job Description -

· 3-5 years of extensive experience in Healthcare Business Analytics, Financial Analysis, or related area

· Bachelor’s degree in Finance, Statistics, Mathematics, Economics, required

Duties

· The Risk and Underwriting Advisor, Retail Network will partner with other Supply Chain teams and cross-functional stakeholders to strategize and deliver client-specific retail network modeling optimization for new business, market checks and renewals.

· These teams include Retail Network Underwriting Analysis, Product, Sales & Account Management (SAM), Core Underwriting, Next Generation Engine (NGE) Support among others. As a part of this team, the Advisor will work with leadership to identify and drive not only modeling improvements but also overall process improvements in the retail network and Supply Chain areas.

· Internally recognized and trusted as the retail network subject matter expert.

· Provides expert content/professional leadership on complex Risk & Underwriting assignments/projects.

· Possesses in-depth product, and financial knowledge.

Essential Functions:

· Collaborate with SAM and Core Underwriting teams to understand current client financial position, RFP requirements and retail network approach as well as strategic options for market checks, renewals, and new business

· Ideate and propose strategic retail network optimization opportunities and understand long-term benefits and challenges associated with those optimization opportunities

· Support Retail Underwriting team leadership by reviewing key/complex client retail network modeling and "translating" modeling primary components and assumptions into concise and understandable format and messaging for leadership reviews and Pricing Committee

· Evaluate client data, create scenarios, and provide expert modeling and guidance for existing and new clients in alignment with department strategic objectives that drive value to both clients.

· In collaboration with Retail Underwriting leadership, Core Underwriting and SAM discuss any potential custom or narrow network options under evaluation to ensure that all modeling and requirements of these network are accurately represented and in alignment with provider contracts

· Partner with Core Underwriting to an a lyze the financial impact of client requested network changes to both the client.

· Strategize with cross-functional areas of client, including but not limited to Account Management, Core Underwriting, Product, Finance, and New Sales

· Participate in interdepartmental team calls as required to discuss retail network financials

· Assist in documenting best practices / SOPs for retail network modeling team

· Assist with optimization of work processes for retail modeling strategies and achievement of department goals

· Work on special projects and presentations as needed for the Retail Underwriting team

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