Job Description

Provides senior-level analytical support for Medical Economics initiatives through the extraction, analysis, and synthesis of complex healthcare data to identify risks, opportunities, and drivers of medical cost and utilization trends. Responsible for developing actionable insights that enhance financial performance, support strategic decision-making, and improve cost of care outcomes. Partners with cross-functional teams to identify, quantify, and monitor emerging trends, develop Scorable Action Items (SAIs) and affordability initiatives, and recommend innovative cost containment strategies. Translates analytical findings into clear, business-focused recommendations that drive operational improvements, medical cost savings, and sustainable financial results.

Essential Job Duties

• Leads medical cost, utilization, and revenue trend analyses across Molina products, identifying emerging opportunities and risks, quantifying financial impact, and communicating actionable recommendations to leadership.
• Identifies, investigates, and explains the root causes of medical cost and utilization trends through the integration of claims, provider, membership, authorization, and financial data.
• Develops, sizes, tracks, and prioritizes Scorable Action Items (SAIs) and other affordability initiatives designed to reduce medical costs, improve efficiency, and enhance financial performance.
• Proactively monitors key cost drivers and emerging healthcare trends, creating analytic frameworks and reporting tools to identify opportunities before they materially impact business performance.
• Designs and develops reports, dashboards, and analytical tools to measure health plan performance, monitor trend drivers, and evaluate the effectiveness of cost containment initiatives.
• Performs financial and ROI analyses to estimate the impact of proposed cost savings initiatives, affordability programs, clinical interventions, and vendor partnerships.
• Draws actionable conclusions through advanced healthcare analytics, predictive modeling, and statistical analysis, translating complex findings into strategic business recommendations.
• Extracts, compiles, and synthesizes data from multiple internal and external sources to support executive decision-making and strategic planning.
• Mines, manages, and interprets large healthcare datasets to uncover patterns, anomalies, and actionable business insights.
• Collaborates with clinical, provider network, finance, payment integrity, and operational teams to validate findings, provide business context, and develop intervention strategies.
• Partners with business owners to establish and monitor key performance indicators (KPIs) for affordability initiatives and medical management interventions.
• Leads analytical projects from concept through implementation, including executive presentations, strategic recommendations, and communication of findings to diverse stakeholder groups.
• Serves as a subject matter expert in Medical Economics analytics, healthcare trend analysis, financial modeling, and opportunity identification.
• Maintains knowledge of Medicaid, Medicare, Marketplace, and healthcare industry developments to assess potential impacts on medical costs, utilization patterns, and affordability strategies.

Required Qualifications

• At least 3 years of health care analytics and/or medical economics experience, or equivalent combination of relevant education and experience.
• Bachelor’s degree in statistics, mathematics, economics, computer science, health care management or related field.
• Demonstrated understanding of Medicaid and Medicare programs or other health care plans.
• Analytical work experience within the health care industry (i.e., hospital, network, ancillary, medical facility, health care vendor, commercial health insurance, large physician practice, managed care organization, etc.)
• Proficiency with retrieving specified information from data sources.
• Experience with building dashboards in Excel, Power BI, and/or Tableau and data management.
• Knowledge of health care operations (utilization management, disease management, HEDIS quality measures, claims processing, etc.)
• Knowledge of health care financial terms (e.g., PMPM, revenue) and different standard code systems (ICD-10CM, CPT, HCPCS, NDC, etc.) utilized in medical coding/billing (UB04/1500 form).
• Demonstrated understanding of key managed care concepts and provider reimbursement principles such as risk adjustment, capitation, FFS (Fee-for-Service), Diagnosis Related Groups (DRG’s), Ambulatory Patient Groups (APG’s), Ambulatory Payment Classifications (APC’s), and other payment mechanisms.
• Understanding of value-based risk arrangements
• Experience in quantifying, measuring, and analyzing financial, operational, and/or utilization metrics in health care.
• Ability to mine and manage information from large data sources.
• Demonstrated problem-solving skills.
• Strong critical-thinking and attention to detail.
• Ability to effectively collaborate with technical and non-technical stakeholders.
• Strong time-management skills, and ability to manage simultaneous projects and tasks to meet internal deadlines.
• Effective verbal and written communication skills.
• Proficient in Microsoft Office suite products, key skills in Excel (VLOOKUPs and pivot tables)/applicable software program(s) proficiency.

Preferred Qualifications

• Proficiency with Power BI and/or Tableau for building dashboards.

To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board.

Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V