Bachelor's degree in business, economics, statistics, mathematics, actuarial science, public health, health informatics, healthcare administration, finance, or related field, or equivalent experience.
4+ years of experience working with large datasets, data management, and analytics; or 2+ years of IT/data-focused experience with healthcare exposure.
Strong experience in Managed Care / Medical Economics analytics and demonstrated knowledge of payment and reimbursement methodologies (DRG, APC, EAPG).
Advanced SQL skills (complex SELECTs, multiple JOINs, subqueries) and Advanced Excel skills (Pivot Tables, Power Query, VLOOKUP/XLOOKUP, financial modeling) and Power BI experience with DAX/Power Pivot.
Requirements:
Analyze Medicare, Medicaid, and Marketplace data to support medical cost, utilization, and reimbursement insights.
Develop and maintain complex SQL queries to extract, validate, and analyze large datasets.
Build and maintain Power BI dashboards using DAX and Power Pivot to track KPIs, MLR, and QAI initiatives; create advanced Excel models for financial modeling.
Collaborate with Medical Economics, Actuarial, Finance, and cross-functional teams; support evaluation of Quality Affordability Initiatives (QAI) and Medical Loss Ratio (MLR) performance; ensure data accuracy through validation, reconciliation, and documentation.
Job description
Data Analyst III – Medical Economics Location: Fully Remote (CST/EST preferred; CA candidates must start ~6:00am PST) Type: Permanent Salary: $85,000–$95,000 base + 8% target bonus Industry: Healthcare / Managed Care Overview We are expanding our Medical Economics team and are seeking a Data Analyst III with strong managed care analytics experience. This role focuses on Medicare, Medicaid, and Marketplace analytics, reimbursement methodologies, and financial performance insights that support affordability, quality, and MLR targets. The ideal candidate has hands-on experience working with large healthcare datasets, payment methodologies, and cross-functional stakeholders, with exposure to actuarial or medical economics workstreams.Key Responsibilities
Analyze Medicare, Medicaid, and Marketplace data to support medical cost, utilization, and reimbursement insights
Develop and maintain complex SQL queries to extract, validate, and analyze large datasets
Perform financial and medical cost analyses related to payment and reimbursement methodologies (DRG, APC, EAPG)
Build and maintain Power BI dashboards using DAX and Power Pivot to track KPIs, MLR, and QAI initiatives
Create advanced Excel models using Pivot Tables, Power Query, nested formulas, and lookups to support financial modeling
Collaborate with Medical Economics, Actuarial, Finance, and other cross-functional teams
Support evaluation of Quality & Affordability Initiatives (QAI) and Medical Loss Ratio (MLR) performance
Ensure data accuracy through validation, reconciliation, and documentation
Required Qualifications
Bachelor’s degree in business, economics, statistics, mathematics, actuarial science, public health, health informatics, healthcare administration, finance, or related field
Equivalent experience considered
4+ years of experience working with large datasets, data management, and analytics
OR 2+ years of IT/data-focused experience with healthcare exposure
Strong experience in Managed Care / Medical Economics analytics
Demonstrated knowledge of payment and reimbursement methodologies (DRG, APC, EAPG)
