Medical Economist

Job Summary

To optimize medical cost management and drive total cost of care strategy, the full-time Medical Economist will evaluate provider contract reimbursement models, collaborate with technical teams for accurate claims adjudication, and deliver actionable intelligence to executive leadership in a remote setting.

Key responsibilities

• Design and evaluate complex provider reimbursement structures and conduct financial modeling for contracts
• Collaborate with cross-functional teams to ensure accurate claims adjudication and identify systemic issues
• Analyze total medical expense trends and provide actionable business intelligence to optimize costs

Required qualifications

• 8+ years of experience in healthcare economics or managed care finance, with 3-5 years in Commercial lines
• Proven expertise in Commercial reimbursement methodologies and contract evaluation
• Experience with claims configuration and adjudication processes
• Proficiency in analyzing large healthcare datasets using SQL, Python, R, or similar tools
• Strong ability to lead cross-functional initiatives and communicate insights to executive leaders