Vice President, Medical Economics

Position Summary:

The leader in this position is responsible for the design, development, and implementation of financial analytics that support BCBSMA's affordability agenda. This includes all Business Case analytics to support the Business Segment, Trend Oversight and Medical Cost Council teams as well as BCBSMA Account Facing Value Proposition insights and reporting. The analytics vary in size and scope, and project the total value of our trend management initiatives in the areas of medical policy, payment policy, care management, pharmacy, health and wellness programs, fraud/waste/abuse, behavior change, unit cost initiatives, product and network redesign for both plan decision making and market facing reporting. In this role, the leader in this position is responsible for developing and maintaining in a collaborative manner with other key business partners new trend management initiative tracking tools and related processes that will clearly articulate the size and scope of each opportunity. The role also includes the development and communication of market segment medical claims expense trends with the aim to provide insights that inform pricing, financial planning, reserving, medical management initiatives, and executive decision making. In addition, the leader in this position is responsible for all production reporting in support of Plan and Account pillars as part of the Enterprise Analytics Oversight Committee. The role highly depends on the leader to be able to articulate drivers of medical & pharmacy expense both at the plan, segment, and account level. It must proactively influence and support the development of new initiatives to improve competitiveness and profitability while also focusing in areas that are responsive to market request. The leader in this role will also proactively collaborate with leaders from ET, the Enterprise Analytics Hub, and other analytic areas to influence the enablement of data for decision making, including enterprise leadership in the transformation of BCBSMA's data infrastructure, governance, and integrity. The leader in this position will need to collaborate with other key staff across the company to ensure consistency and transparency in data and information sharing across a wide continuum of functional areas Also, the leader in this position will need to build strong and trusted relationships with several cross-functional business partners outside of Finance, spanning multiple layers of the organization from analyst to SVP, including Sales & Segmentation, Pharmacy, ET, and Health Care Services (Health & Wellness and Medical Innovation & Leadership areas), in order to fully and effectively execute on medical expense goals and development of market leading account reporting. This leader manages a team of 3-5 of leaders to help develop and execute on aligned goals.

Key Accountabilities:

• Lead the development of analytics to support new trend management initiatives in the areas of medical policy, payment policy, care management, pharmacy, behavior change, health and wellness programs, unit cost initiatives, and several other areas.
• Leverage advanced analytics including data science disciplines such as machine learning and artificial intelligence to develop deep understanding of medical cost and trend drivers in order for the organization to both inform mitigation interventions and better articulate and anticipate changes in trend.
• Actively partner with segment leaders on medical and pharmacy trend drivers in order to shape potential segment initiatives and drive performance.
• Works in collaboration with Segment leaders and support staff to monitor segment trends, produce valuable account reporting and advance understanding of medical cost drivers and initiatives to improve competitiveness and profitability.
• Serve as BCBSMA's healthcare cost trend "ambassador", both internally and externally, identifying and communicating macro themes and micro drivers of trend.
• Partner with Actuarial pricing and forecasting teams to inform healthcare cost trend predictions.
• Partner with Pharmacy Analytics team to integrate medical and pharmacy expense insights.
• Lead the strategic development and implementation of plan and account reporting that supports the organization's evolving strategies around affordability, products, health engagement, and segmentation/profitability.
• Lead ad hoc and drilldown analytic support from front to back for both plan and accounts
• Direct and lead the development of financially focused predictive tools and analytics to enable enhanced Plan and account-based insights and reporting.
• Proactively collaborate with leaders from IT and other analytic areas to influence the enablement of data for decision making, including enterprise leadership in the transformation of BCBSMA's data infrastructure, governance, and integrity.
• Provide enterprise-wide leadership in analytics coordination and effectiveness throughout the organization.
• Acting as a strategic partner to numerous corporate areas that include Product, Health and Medical Management, Sales, IT, and many others with a focus on
  • Development of initiatives to improve members health and health care quality and moderate claims trends
  • Design, implementation, and measurement of account analytics that highlight BCBSMA value and are responsive to the market.
• Challenge and motivate staff to reach their highest potential, foster continuous professional development and career growth of diverse workforce.
• Comply with reporting requirements & requests from State and Federal regulatory authorities.
• Oversee the execution of reporting of information that is complex and unique to various market segments while applying diligence around policies related to sensitive information and compliance with regulatory guidelines

Challenges/Problem Solving:

• Providing leadership and participating on critical business teams impacting Plan and Account business objectives. Including those with senior leadership representation (SVP, VP). Examples include Medical Expense Team, Segment Leaders, Enterprise Analytics Executive Team, Market Reporting Oversight Team, Pharmacy Leadership Committee, Data Access Layer Steering, Medical Cost Council and EMT as necessary.
• Balance sense of urgency and competing priorities across all key customers of Medical Economics and Pharmacy Analytics
• Enhance and Develop flexible analytic models and tools to meet rapid and changing needs in a fast-paced, evolving market
• Work closely with other core analytic teams and IT to ensure maximum use of resources and tools while also driving for results. Provide leadership in analytics coordination and effectiveness throughout the organization.

Decision Making Authority:

• Evaluate models, tools, tracking processes, and other analytic solutions necessary to support the organization's current and emerging business strategies related to Trend Management goals.
• Research, influence, and make recommendations on industry best practices related to areas of key accountabilities for analytics.

Leadership Responsibilities:

• Provide strong customer focus and ability to work effectively in matrix environment.
• Enable strong business partnership to influence strategic direction of plan and account goals.
• Effectively collaborate with cross functional leaders to align goals and set priorities
• Lead a team to work independently, be results focused, and demonstrate flexibility with new or varied responsibilities. Empower leaders to innovate and deliver value that improves competitiveness and profitability
• Acts as the back-up and spokesman for the SVP & Chief Actuary and operates as a department ambassador for projects that support the strategic vision of the division and of BCBSMA.

Qualifications (knowledge/skills/abilities/behaviors):

• Deep and broad understanding of health care delivery system and health plan operations, including knowledge of Medical Economics, Trend Management, Pricing, Forecasting, Provider Payment Methodologies, and industry benchmarks.

• Strong understanding of data science techniques and how they can be leveraged in practical ways to understand medical expense trends as well as to identify, value and measure medical expense affordability initiatives.
• Team oriented/collaborative - ability to work with senior management team to ensure achievement of corporate goals

• Display strong verbal, communication, and presentations skills to all levels of the organization.
• Executive presence and ability to influence strategic priorities at senior levels of organization
• Strategic thinking and execution
• Excellent customer service to internal and external clients
• Solid risk assessment and management skills with the ability to take intelligent risks.
• Demonstrated results orientation with a creative problem-solving ability within complex financial
• Strong tactical negotiation skills when managing complex and technical articulation of the financial issues.

Education/Relevant Experience:

• 10+ years of health care experience including experience in the areas of Medical Economics, Industry Benchmarking Best Practices, and Provider and/or Account Informatics.
• Direct experience leading and managing staff required.
• BA/BS required; FSA, MBA or other advanced degree required

High school degree or equivalent required unless otherwise noted above

The job posting range is the lowest to highest salary we in good faith believe we would pay for this role at the time of this posting. We may ultimately pay more or less than the posted range, and the range may be modified in the future. An employee's pay position within the salary range will be based on several factors including, but limited to, relevant education, qualifications, certifications, experience, skills, performance, shift, travel requirements, sales or revenue-based metrics, and business or organizational needs and affordability.

This job is also eligible for variable pay.

We offer comprehensive package of benefits including paid time off, medical/dental/vision insurance, 401(k), and a suite of well-being benefits to eligible employees.

Note: No amount of pay is considered to be wages or compensation until such amount is earned, vested, and determinable. The amount and availability of any bonus, commission, or any other form of compensation that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company's sole discretion, consistent with the law.

WHY Blue Cross Blue Shield of MA?

We understand that theconfidence gapandimposter syndromecan prevent amazing candidates coming our way, so please don't hesitate to apply. We'd love to hear from you. You might be just what we need for this role or possibly another one at Blue Cross Blue Shield of MA. The more voices we have represented and amplified in our business, the more we will all thrive, contribute, and be brilliant. We encourage you to bring us your true colors, , your perspectives, and your experiences. It's in our differences that we will remain relentless in our pursuit to transform healthcare for ALL.

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