Senior Health Analyst

7 days ago


Philadelphia, Pennsylvania, United States Verily Full time
About the Role

We are seeking a highly skilled Senior Analyst, Health & Risk Solutions - Cost of Care to join our team at Verily. This role will play a critical part in identifying and leading initiatives to support our Precision Risk Stop Loss product and drive its execution with our Ecosystem Partners.

Key Responsibilities
  • High-Risk Member Identification: Identify clinical composition of high-risk members, comparing inbound data to actuarial benchmarks by identifying members on their rising risk predictors using the clinical condition input to evaluate segmentation for clinical or network programs.
  • Cost Containment Strategies: Develop best practices and cost containment strategies and benefit designs around outpatient, inpatient, pharmacy, and professional spend, underwriting, and claim reimbursement operations.
  • Ecosystem Partner Assessment: Assess the ecosystem to leverage innovative solution partners and programs to ensure that our members receive high-value and appropriate care.
  • Healthcare Cost Analysis: Investigate claim, case, and underwriting data for performing healthcare cost analysis and develop savings measurement models to identify and implement strategies to control costs.
  • Project Management: Work on projects assigned on ecosystem partner assessment/engagement and strategizing cost containment opportunities in partnership with clinical team, IT, account management, and business partners.
Qualifications
  • Education: Undergraduate degree (BA/BS) with 3+ years of experience in a managed care, health plan, payor, or provider-related field and 5+ years of healthcare industry experience.
  • Skills: Acumen in two or more of the following areas: Financial, Actuarial, Medical Economics, Affordability, Population Health, Clinical Analytics, and Project Management.
  • Knowledge: Working knowledge of ICD10, DRG, CPT codes, Bill Reviews, and PPO contracts.
Preferred Qualifications
  • Advanced Education: MBA, MHA, MA
  • Certifications: PMP or Six Sigma Green Belt
  • Experience: Prior experience with one or more of the following: claims processing, clinical strategy, finance, or operations.
  • Technical Skills: MS Office Suite of tools desired, advanced Excel experience, SQL, Tableau, or other reporting tools.
  • Soft Skills: Strong strategic thinking, problem-solving, and communication skills.
About Verily

At Verily, we are a diverse team of builders innovating at the intersection of health and technology. We are united by a shared spirit of curiosity, resilience, and determination to make better health possible for all. Our culture reflects the behaviors that stem from living our values every day in how we Innovate Healthcare and Technology, Gain Velocity as One Verily, and Respect Individuals.

We offer flexibility, resources, and competitive benefits to support you in your whole-person well-being. Our culture is built on a VIBE (Verily's Culture of Inclusion, Belonging, and Equitability) where all Veeps feel included, a sense of belonging, and have opportunities to grow.



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