Healthfirst · 19 hours ago
Senior Analyst, Total Cost of Care
New York, NY
Full-time
Hybrid
Mid, Senior Level
$83K/yr - $120K/yr
3+ years expHealthfirst is a healthcare company that offers a variety of products and services. The Senior Analyst, Total Cost of Care, will develop analyses and tools to monitor financial performance and provide analytic insights into all products within the Healthfirst portfolio, focusing on medical trend and cost savings.
Commercial InsuranceHealth CareHealth InsuranceInsurance
Responsibilities
Develop actionable analytic tools to help monitor medical cost and utilization trends, provide concise insight into the root cause drivers, and work with the team to develop potential remediation opportunities
Develop savings analyses for Medical Economics cost trend reduction initiatives, applying financial modeling expertise and using independent judgement to determine best valuation methods
Prioritization of cost mitigation activities across business areas
Provide actionable data driven analysis to Finance, Claims, Pharmacy, Payment Integrity, Medical Management, Network, and other departments to enable critical decision making
Evaluate data to identify and root cause of payment integrity issues and lead cross-functional efforts to problem solve
Develop interactive financial models to evaluate the impact of provider reimbursement changes
Support all provider settlement and data reconciliation activities
Support maintenance of tools to define profitability dashboards by product
Keep abreast of New York Medicaid and Medicare reforms, reimbursement methodologies, and their impact on Healthfirst and their owner hospital performance
Perform ad hoc analyses
Qualification
Required
Bachelor's Degree from an accredited institution
At least three (3) years of healthcare analytics experience, with at least two (2) years of experience in contract evaluation, medical economics, medical cost containment, actuarial, healthcare reimbursement model design
Extensive knowledge of managed care financial metrics (PMPM, util/k, cost/unit)
Experience utilizing healthcare claims data to uncover valuable insights to improve financial performance
Experience with Government and proprietary payor reimbursement methodologies and unit cost management
Experience with SAS or SQL (creates queries and manipulation of data)
Extensive experience with Microsoft Excel (building financial models, utilizing pivot tables, vlookups, index match, and calculated fields)
Claims experience including root-cause analysis, system set-up, etc
Ability to work with large data sets
Strong written and verbal communication skills
Resourceful and creative in solving complex issues and working corroboratively with others on a solution
Ability to manage projects and project plans within stated timelines
Preferred
Expertise in 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 using Tableau, Python
Experience mentoring other team members
Benefits
Medical, dental and vision coverage
Incentive and recognition programs
Life insurance
401k contributions
Company
Healthfirst
Healthfirst is a health insurer providing medical, business, and health insurance services.
1001-5000 employees
Funding
Current Stage
Late StageLeadership Team
Pat Wang
President and CEO
Recent News
2026-01-22
2025-10-10
Crain's New York Business
2025-09-23
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