Since 1985, MetroPlusHealth has helped the people of New York City get quality health care at little to no cost. MetroPlusHealth is the plan of choice for over 712,000 New Yorkers, and its commercial and government-sponsored plans meet the needs of individuals, families, and workforces. The MetroPlusHealth staff speaks more than 40 languages and is as diverse as the great City it serves. MetroPlusHealth is part of NYC Health + Hospitals, the nation's largest public health system.

The purpose of this position is to utilize MetroPlusHealth’s data to provide financial analysis related to the provision, payment, and reporting of health care services. The position is also responsible for research, collection, analysis, and presentation of the Plan’s utilization and financial data. Candidates interested must work with multiple departments within the Plan in an effort to coordinate analytics to enhance operational efficiencies.

Job Description

• Prepare financial analyses on various aspects of the financial operations of the Plan including revenues, expenses, utilization, and membership.
• Prepare financial analyses of medical services from large-shared databases utilizing queries and multiple-level extracts.
• Participate in the production and quality review of monthly and regulatory reports, including but not limited to the Medicaid Managed Care Operating Report (MMCOR).
• Prepare projection analyses on claims and utilization, including underlying trends and risk analysis.
• Prepare documentation and policies and procedures of all reporting and analyses.
• Review and update categorization logic for claims analysis.
• Prepare various monthly accrual deliverables to the Accounting Department
• Organize and manage large and varied data sets.
• Analyze healthcare data to optimize business operations.
• Convert data into usable information that is easy to understand.
• Communicate findings using data visualization and detailed reports.
• Create quarterly reporting package for executives.
• Communicate monthly with Actuaries for data gathering, QA, communication, and completion of the Unpaid Claims Liability (UCL).
• Collect, investigate, and analyze data to identify patterns, trends, insights, and solutions.
• Special projects and other related duties as assigned.

Minimum Qualifications

• Bachelor’s degree required
• 5+ years of relevant experience in business, health care, consulting, insurance, government, or related industry
• Proficiency in Microsoft Excel, Access and Word is required
• SQL Query skill is required.
• Experience with statistical systems and data report writers.
• Insurance operations experience preferred

Professional Competencies

• Integrity and Trust
• Customer Focus
• Functional/Technical skills
• Excellent verbal, written and mathematical skills.