Job Opportunities API

Job Description • Manage, analyze, and report medical and pharmacy claims to identify cost drivers, utilization trends, and opportunities to optimize benefit design and vendor performance. • Develop trend analyses and forecasting models to support healthcare cost projections, budgeting, and scenario planning. • Apply industry knowledge and data analysis to identify inefficiencies, cost drivers, and performance gaps and recommend strategies to improve spend while protecting member outcomes. • Conduct benchmarking analyses to assess the competitiveness of benefit programs and identify gaps and opportunities for improvement. • Evaluate and recommend benefit design changes (e.g., medical, dental, vision, disability, life insurance) to support effective plan management, cost efficiency, and a strong employee experience. • Define key financial, clinical, and utilization metrics to assess health plan performance and establish reporting to monitor those indicators. • Facilitate internal Chief Medical Officer involvement through regular updates and escalation of material clinical, utilization, or cost trends, as needed. • Support evaluation of clinical programs, including case management initiatives and related vendor partnerships, to assess impact on health outcomes and cost of care. • Evaluate plan and vendor performance (financial, clinical, operational, and member experience outcomes, including ROI analysis) to support contract renewals and strategic partnerships. • Support benefits strategy and leadership through analysis, reporting, and recommendations related to benefit programs and plan design. • Develop and present clear, compelling materials that communicate key insights and recommendations to senior-level executives. • Lead projects by aligning stakeholders, communicating progress, and ensuring timely delivery of required work products. • Identify opportunities to leverage on-site health centers to improve member health outcomes and reduce external claims costs. • Perform other duties and special projects as assigned by the Sr. Director, Health Plan and Benefits.