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Under executive direction, the Associate Director Medex/DW Healthcare Economics Optum Massachusetts is responsible for all aspects of assessing, evaluating, and estimating outside medical expenses and claims data warehouse for Optum Massachusetts. Responsible for complex trend analysis and reporting to inform senior management's decision making regarding the level of changes for financial statement reporting. Makes recommendations and provides critical professional expertise to inform senior management of amounts to record in the financial statements. Assesses and ensures the integrity, accuracy and consistency of the financial and utilization reports and databases and leads action plans for making improvements. Manages staff, consisting primarily of financial analysts. As the accountable business owner, oversees the implementation of changes to the databases, reports, and processes as dictated by changes in business needs to support the recording of outside medical expenses in the financial statements.
You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges. For all hires in the Minneapolis or Washington, D.C. area, you will be required to work in the office a minimum of four days per week.
Primary Responsibilities
- Oversee all aspects of calculation of outside claims expense and related reserves under hospital and payer risk contracts. Has overall responsibility for monthly calculation of expenses, liabilities, and accounts receivable related to payer risk contracts
- Manages the monthly process of outside medical expense projections, the population of reporting and analytic databases, and the required reporting and analysis of inpatient and outside utilization expenses
- Performs the monthly analytic review and interprets enterprise-wide, and site specific, trends and variances. Based on this analysis, makes critical recommendations to leadership on amounts to record in the monthly financial statements. Develop new financial and utilization reports and analyses as needed
- Supporting all amounts recorded by accounting and ensuring that proper financial controls are in place to verify amounts recorded
- Partners with business leaders and build solid relationships in support of financial performance; acts as a strategic thought-partner for the business
- Drives intersegment agreements between Optum Massachusetts and UHC entities along with understanding the financial impacts
- Responsible for: quarterly forecasts of all outside medical expense accounts, and related deliverables (i.e, bridges, trend reporting, supplemental schedules as applicable); Atrius forecast model for medical expense rates; creation of trends to ascertain year over year changes, experience, etc.
- Partners across Optum Massachusetts Finance team to help lead integration activities
- Manages the monthly preparation of complex payer medical expense trend analyses for discussion at monthly financial statement meetings
- Provides recommendations on inpatient and outside utilization expense levels and directs the creation of monthly journal entry to record outside medical cost
- Develops and maintains on-going relationships with outside providers, payers and other external parties regarding data feeds, outside provider discounts and reinsurance issues. Directs the calculations and reconciliations of risk-sharing settlements with payers and hospitals. Has responsibility for contractually required medical claims expense and utilization reporting under risk-sharing arrangements with hospitals
- Works directly with the actuaries and outside auditors on evaluation of the sufficiency of recording for hospital and outside utilization expense. As an expert, provides detailed support to auditors for the purpose of their actuarial assessments. Monitors amounts recorded against claims "run out". Works with financial auditors to validate medical claims expense and liabilities under payer and hospital risk contract/risk-sharing arrangements
- In the business owner role, contact payers to enable the data warehouse to be populated with accurate and correct data. has responsibility for the calculation and monitoring of claims liability reserves from prior years' risk arrangements
- Provides financial expertise and recommends support to clinical leadership initiatives to manage outside medical expenses by providing expertise in valuing the potential savings impact of initiatives; by communicating cost trends; and adding expertise based on claims knowledge on how performance can be tracked. has responsibility for monthly outside medical claims utilization and expense reporting
- Provides leadership bridge between external and internal services of medical expertise information. Provides business rules for IT analysts to program accurate translation of monthly and annual payer data files needed to populate the enterprise data warehouse. This data warehouse is the key data repository necessary for monitoring and reporting outside medical costs
- Administers all medical cost/managed care analytics related to capitated arrangements with insurance including Purchased Services and the production of all routine reports, General Ledger entries, lag grids, quarterly invoices, projections, budget and all requested ad hoc analyses. Responsible for maintenance and auditing the related claims information in the performance analytics system (DMS)
- Works collaboratively with Contracting to provide data, analytic support, and expertise in support of payer and hospital risk management negotiations. Recommend proposals to Contracting. Supports Contracting Department discussions and evaluation of managed care contract terms; may propose changes in the contracts to the Contracting Department Leadership. Provides input and information to facilitate successful payer negotiations on expense trends and payer financial performance; works closely with the Contracting Department to estimate and manage the preparation of detail settlement documents for recovery of funds based on contractual arrangements with payers and hospital risk-sharing partners. Responsible for reconciling outside medical expenses associated with annual and interim settlements of the capitation risk contracts. Works collaboratively with the Controller to reach agreement on the final annual contract financial results
- In conjunction with senior management, collaborates on the annual hospital and outside utilization budgets and year-end/multi-year projections, including managing complex provider discounts and reinsurance. Directs pharmacy trend analysis related to the managed care contracts and supports understanding of these trends relative to in-house and network pharmacy expenses
- Manages and oversees the relationship with outside reinsurance broker and provides information according to contractual requirements. Participates in the evaluation of new reinsurance coverages and makes recommendations for program improvements
- Working closely with Data Analytics and Data Warehouse leadership to support data quality initiatives and direct management of transitions of payer data from new contracts or changes in contractual terms. Serves as a primary source of business expertise for Data Warehouse and Data Analytics teams
- Develops, on an as-needed basis, estimations of outside medical expenses for evaluation of new ventures and affiliations
- Performs other duties as assigned
You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.
Required Qualifications
- Bachelor's degree (or equivalent experience) required, preferably in accounting, finance, mathematics or actuarial science. MBA preferred. Actuarial Certification a plus
- 5+ years of experience in financial data analysis
- 5+ years of experience in healthcare or health insurance
- Experience in supervisory or lead role
- Background in financial modeling and forecasting
*All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy
Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $112,700 - $193,200 annually based on full-time employment. We comply with all minimum wage laws as applicable.
Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.
At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission.
OptumCare is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.
OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.