Match score not available

Analytics Associate Vice President

Remote:

Full Remote

Salary:

172 - 242K yearly

Experience:

Expert & Leadership (>10 years)

Work from:

United States

Offer summary

Qualifications:

Bachelor's Degree in Statistics or related field, 7-10 years of experience in healthcare analytics, Expert understanding of healthcare claims and billing, Certified Employee Benefits Specialist (CEBS) required.

Key responsabilities:

Analyze health plan financial results and trends
Support underwriting with renewal and proposal calculations

Western Growers Family of Companies Non-profit Organization - Charity SME https://www.wga.com/

201 - 500 Employees

See all jobs

Job description

Description

If you’re looking for a career that provides affordable health benefit solutions to the people who support some of the most vital industries, we’re looking for you.

At Pinnacle Claims Management, we are an innovative third-party administrator (TPA) that provides a full-suite of comprehensive and customized health benefits administration services for self-funded companies, including health management and wellness solutions, and pharmacy benefit management. We are also a proud contracted partner with Covered California. As part of the Western Growers Family of Companies, we are committed to providing our employees with everything they need to succeed and grow. We know that taking care of our clients starts with taking care of our employees.

As a keystone of our philosophy, we recognize that every person on our team comes to us with a unique background, history and story that adds strength to our organization. Additionally, employees are encouraged to recognize that there isn’t a work life and a home life, there is one life. This recognition throughout the organization emphasizes the value of finding a healthy and happy balance in every employee’s life. One way this is realized for employees of Pinnacle Claims Management is flexible work arrangements with work-from-home, in-office or hybrid options.

With competitive compensation packages, premier investment support, enriching personal development and more, we strive for our employees’ job satisfaction and success.

Compensation: $172,466 - $242,141 with a rich benefits package that includes profit-sharing.

Job Description Summary

Formulate and apply mathematical modeling and other optimizing methods to develop and interpret information that assists executive management with decision making, policy formulation, or other managerial functions as it relates to the products and services of a multiple employer welfare arrangement trust (MEWA), Western Growers Assurance Trust (WGAT), and a third-party administrator (TPA), Pinnacle Claims Management, Inc. (Pinnacle). The changes to pricing or products can include fully-funded employer sponsored health care, pharmacy costs (pricing structure and rebates), third party administer fee structure and other related ancillary products. May collect and analyze data and develop decision support software, services, or products. Position reports to the Chief Operating Officer (COO) and has no direct reports.

Qualifications

Bachelor's Degree in Statistics, Computer Science, Mathematics, Economics, Actuarial Science, or a related field seven to ten years of experience in analyzing and modeling risk with health plans across various group sizes (large and small group) and funding (fully insured, self-insured, and partially self-insured) preferred.
Expert level understanding of healthcare claims taxonomy, billing procedures, and reporting standards across the insurance industry.
Experience in healthcare analytics platforms such as Springbuk and Cedargate Technologies.
Proven ability to analyze the cost benefit of changing the structure of health benefits.
Certified Employee Benefits Specialist (CEBS) or similar designation required.
Resident in California a must.
Internet access provided by a cable or fiber provider with 40 MB download and 10 MB upload speeds.
Home router with wired Ethernet (wireless connections and hotspots are not permitted).
A designated room for home office or steps taken to protect company information (e.g., facing computer towards wall, etc.)

A functioning smoke detector, fire extinguisher, and first aid kit on site.

Duties And Responsibilities

Healthcare Analytics

Summarize and present to internal and external stakeholders’ health plan financial results identifying trends, cost drives, outliers, and present predictive models on future claims and expenses.
Present ways to reduce the cost of claims and ultimately health costs to the client/member
Suggest ways to design the plans to garner savings in expenses or improvement in benefits to participants
Provide analysis of impact of potential plan changes under consideration, weighing financial outcomes with their probability and impact to participants experience
Evaluate and make recommendations on vendors providing point solutions

Underwriting and Actuarial Analysis

Support WGAT underwriting with renewal and proposal calculations.
Present ways to reduce the cost of claims and ultimately health costs to the client/member.
Suggest ways to design the plans to garner savings in expenses, determine contract rate trends with providers
Alert senior executives in e.g. COO and chief financial officer (CFO) of external forces impacting the cost of coverages.

Sales and Renewals

As a valued partner present potential prospects as the key subject matter expert in benefits analytics to promote sales for both fully funded WGAT and self-funded Pinnacle clients. In addition, be available for expert consultation for existing clients to ensure client satisfaction and retention. Partner with the Underwriting Department Colleagues
Work with the Underwriting team and blend into the underwriting discussions, be a change agent in how the organization views claims.
Get curious and use the Company’s data and systems to drive predictive modeling conversations for the purpose of plan change recommendations to the client.
Use data analytics in a fresh way to determine trends and predictive modeling.

Research and Development

Determine what the competitors are doing in the same products and services space and in different geographical areas around the State.
Find and report what the large carriers are doing relative to the pricing and services with the different metal plans. Make suggestions to recalibrate the WGAT and PCMI products relating to coverage, co-pay, deductibles.
Every year make a well-informed and researched recommendation to recalibrate the metal tiers.
Find ways to drive lower costs and present them to the COO and CFO, at the same time guarding against losing competitive advantage in the marketplace.
Make suggestions to plan designs to move patients to outpatient care when appropriate.

Other

Utilize all capabilities to satisfy one mission — to enhance the competitiveness and profitability of our members. Do everything possible to help members succeed by being curious and striving to understand what others are trying to achieve, planning, and executing work helpfully and collaboratively. Be willing to adjust efforts to ensure that work and attitude are helpful to others, be self-accountable, create a positive impact, and be diligent in delivering results.
Maintain internet speed of 40 MB download and 10 MB upload and router with wired Ethernet.
Maintain a HIPAA-compliant workstation and utilize appropriate security techniques to ensure HIPAA-required protection of all confidential/protected client data
Maintain and service safety equipment (e.g., smoke detector, fire extinguisher, first aid kit).

All other duties as assigned.

Physical Demands/Work Environment

The physical demands and work environment described here represent those that an employee must meet to successfully perform this job’s essential functions. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this job, the employee is regularly required to communicate with others. The employee frequently is required to move around the office. The employee is often required to use tools, objects, and controls. This noise level in the work environment is usually moderate.