59 Healthcare Economics jobs in the United States

Summary:

• Work with other team leaders to improve operational efficiencies and resource allocations for improved performance of the EmblemHealth plans.
• Responsible for running queries and providing required analysis to understand related drivers (such as medical cost and utilization), and to provide insightful commentary and sensitivity modeling analysis.
• Develop data-driven analysis for decision making on how EmblemHealth purchases, manages, and influences the cost of care for current and prospective members.
• Extract, analyze, and interpret data for more complex insights related to cost drivers and to manage the escalation of issues that impact costs, and impact of health cost containment initiatives.
• Provide consultative subject matter expertise to aligned business areas to demonstrate analytics rooted in data.

Responsibilities:

• Ensure data integrity is maintained throughout the reporting lifecycle.
• Implement reporting and reconciliation workflows and document processes.
• Responsible for experience studies and medical trend studies.
• Perform research and collection of data, including data mining and reporting, which is provided to various customers inside and outside the department.
• Implement automation of manual reporting and analysis of business implications and trends.
• Lead efforts to continually improve data capabilities and quality of department analysis and reporting.
• Create, develop, and design analytics and reporting to measure or estimate financial impact of health plan business problems and potential or actual solutions, addressing escalated issues with subject matter expertise.
• Lead and manage several corporate and health cost containment initiatives, supporting staffing to deliver results across all functions within Medical Economics including.
• Develop research and analytic processes to review financial data to draw conclusions for senior leadership.
• Represent the department to internal and external partners with presentation of data and results for use in administering specific programs and processes related to medical expense and utilization.
• Present analytical findings to internal business partners, leading discussions and providing delivery of further analysis.
• Analyze business problems related to financial experience of the health plan, particularly related to how care is purchased, managed, or other factors influencing cost of care.
• Perform additional duties as assigned.
  

Requirements:

• BA/BS in Mathematics, Statistics, Economics, Healthcare or related discipline required; Master's preferred
• 4 - 6+ years' experience working in a healthcare setting (within a provider health system or health insurance company) required
• Ability to query, summarize, and manipulate data using SQL or SAS required
• High level of proficiency with MS Office (Word, Excel, PowerPoint, Outlook, etc.), with an emphasis on Excel required
• Experience working with healthcare data including but not limited to claims, testing results and pharmacy data required
• Strong communication skills (verbal, written, presentation, interpersonal) required
• Experience preparing/presenting dashboards and data using a data visualization tool such as Tableau required

Additional Information

• Requisition ID: 10002439
• Hiring Range: $68,040-$118,800

At UnitedHealthcare, we're simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and equitable. Ready to make a difference? Join us to start **Caring. Connecting. Growing together.**
No industry is moving faster than health care. And no organization is better positioned to lead health care forward than UnitedHealth Group. We need attention to every detail with an eye for the points no one has considered. The rewards for performance are significant. As a Health Care Economics Consultant, you will perform critical research and investigation of key business problems. Using phenomenal analytical skills, you will develop and improve quantitative data analytics and set performance targets for the enterprise. As a subject matter expert, you will interpret and analyze claims and non claims data from various sources and recommend best approaches for its consolidation. You will cleanse, transform and manipulate data to tell analytic stories with data visualizations. There are new challenges and bigger rewards around every turn. Now is the time, and this the place where you'll find a career in which you can make a big difference in our company, our industry, even our world. Join us.
Positions in this function will be responsible for researching and investigating key business problems through quantitative analyses of utilization and healthcare costs data. Develop and improve quantitative data analytics and set performance targets.
You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.
**Primary Responsibilities:**
+ Interpret and analyze claims data from various sources and recommend best approaches
+ Create and update automated processes
+ Produce and review reports
+ Analyze healthcare data to identify trends, patterns, and insights
+ Develop and maintain data models, reports, and dashboards
+ Collaborate with various departments to ensure data accuracy and consistency
+ Provide actionable recommendations based on data analysis
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 required in economics, health economics, actuarial science or related quantitative discipline
+ 2+ years of programming experience in a professional and/or educational setting
+ Programming experience in either SQL, Python or R at beginner or intermediate level
+ Experience with data reporting and analysis
+ Proven excellent analytical and problem-solving skills
+ Proven excellent attention to detail and accuracy
+ Proven excellent communication and interpersonal skills
+ Ability to work independently and as part of a team
+ Proven intermediate Excel skills
**Preferred Qualifications:**
+ Experience within healthcare industry
+ Reporting skills using software like PowerBI
*All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy
**California, Colorado, Connecticut, Hawaii, Nevada, New Jersey, New York, Maryland, Rhode Island, Washington, Washington, D.C. Residents Only:** The salary range for this role is $58,300 to $114,300 annually. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable. In addition to your salary, UnitedHealth Group offers 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 UnitedHealth Group, you'll find a far-reaching choice of benefits and incentives.
**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._
_Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law._
_UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment._

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start **Caring. Connecting. Growing together.**
You will enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.
**Primary Responsibilities:**
+ Develop and maintain highly optimized Tableau dashboards to support Risk Adjustment reporting and analytics
+ Write and manage efficient, scalable SQL code to support data pipelines and dashboard requirements
+ Perform ad-hoc analysis to support decision-making and business needs across Risk Adjustment initiatives
+ Maintain thorough documentation, including dashboard reference materials and development logs
+ Support the migration of existing reports and dashboards from Tableau to Power BI where needed
+ Troubleshoot data or performance issues related to dashboards and underlying queries
+ Collaborate cross-functionally with clinical, business, and analytics teams to translate requirements into actionable reporting solutions
+ Ensure data accuracy and quality through validation, QA checks, and proactive monitoring
+ Manage the full lifecycle of dashboard development-from requirements gathering to deployment and user support
+ Stay current on CMS Risk Adjustment guidelines to ensure accurate and compliant reporting
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:**
+ High School Diploma/GED (or higher)
+ 4+ years of experience in healthcare analytics role including Tableau development
+ 4+ years of experience with SQL
+ 2+ years of experience with Power BI
+ 2+ years of experience with Snowflake
**Preferred Qualifications:**
+ Bachelor's degree in quantitative field such as Statistics, Mathematics, Engineering Finance, Health Administration, or other related field
+ 6+ years of experience in healthcare analytics
+ Experience integrating Python scripts within Tableau using TabPy for advanced calculations and model-driven visualization
+ Risk adjustment experience
+ Knowledge of CMS regulations and Medicare Advantage risk adjustment methodologies such CMS-HCC model (Hierarchical Condition Category), and risk score calculation
+ Proficiency in Power BI, especially in the context of transitioning Tableau reports
+ Strong attention to details and accuracy
+ Strong problem-solving skills and analytical thinking across data visualization, analysis, and reporting.
+ Strong communication and documentation skills to support cross-team collaboration
+ Demonstrated commitment to data accuracy and a strong ability to present data through impactful visual storytelling.
+ Exposure to AI capabilities
+ Expert in Python or R
*All Telecommuters 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 $89,900 to $160,600 annually based on full-time employment. We comply with all minimum wage laws as applicable.
Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records.
**_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._
_UnitedHealth Group 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._
_UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment._
#RPO #GREEN

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start **Caring. Connecting. Growing together.**
You will enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.
**Primary Responsibilities:**
+ Develop and maintain highly optimized Tableau dashboards to support Risk Adjustment reporting and analytics
+ Write and manage efficient, scalable SQL code to support data pipelines and dashboard requirements
+ Perform ad-hoc analysis to support decision-making and business needs across Risk Adjustment initiatives
+ Maintain thorough documentation, including dashboard reference materials and development logs
+ Support the migration of existing reports and dashboards from Tableau to Power BI where needed
+ Troubleshoot data or performance issues related to dashboards and underlying queries
+ Collaborate cross-functionally with clinical, business, and analytics teams to translate requirements into actionable reporting solutions
+ Ensure data accuracy and quality through validation, QA checks, and proactive monitoring
+ Manage the full lifecycle of dashboard development-from requirements gathering to deployment and user support
+ Stay current on CMS Risk Adjustment guidelines to ensure accurate and compliant reporting
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:**
+ High School Diploma/GED (or higher)
+ 4+ years of experience in healthcare analytics role including Tableau development
+ 4+ years of experience with SQL
+ 2+ years of experience with Power BI
+ 2+ years of experience with Snowflake
**Preferred Qualifications:**
+ Bachelor's degree in quantitative field such as Statistics, Mathematics, Engineering Finance, Health Administration, or other related field
+ 6+ years of experience in healthcare analytics
+ Experience integrating Python scripts within Tableau using TabPy for advanced calculations and model-driven visualization
+ Risk adjustment experience
+ Knowledge of CMS regulations and Medicare Advantage risk adjustment methodologies such CMS-HCC model (Hierarchical Condition Category), and risk score calculation
+ Proficiency in Power BI, especially in the context of transitioning Tableau reports
+ Strong attention to details and accuracy
+ Strong problem-solving skills and analytical thinking across data visualization, analysis, and reporting.
+ Strong communication and documentation skills to support cross-team collaboration
+ Demonstrated commitment to data accuracy and a strong ability to present data through impactful visual storytelling.
+ Exposure to AI capabilities
+ Expert in Python or R
*All Telecommuters 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 $89,900 to $160,600 annually based on full-time employment. We comply with all minimum wage laws as applicable.
Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records.
**_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._
_UnitedHealth Group 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._
_UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment._
#RPO #GREEN

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start **Caring. Connecting. Growing together.**
You will enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.
**Primary Responsibilities:**
+ Develop and maintain highly optimized Tableau dashboards to support Risk Adjustment reporting and analytics
+ Write and manage efficient, scalable SQL code to support data pipelines and dashboard requirements
+ Perform ad-hoc analysis to support decision-making and business needs across Risk Adjustment initiatives
+ Maintain thorough documentation, including dashboard reference materials and development logs
+ Support the migration of existing reports and dashboards from Tableau to Power BI where needed
+ Troubleshoot data or performance issues related to dashboards and underlying queries
+ Collaborate cross-functionally with clinical, business, and analytics teams to translate requirements into actionable reporting solutions
+ Ensure data accuracy and quality through validation, QA checks, and proactive monitoring
+ Manage the full lifecycle of dashboard development-from requirements gathering to deployment and user support
+ Stay current on CMS Risk Adjustment guidelines to ensure accurate and compliant reporting
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:**
+ High School Diploma/GED (or higher)
+ 4+ years of experience in healthcare analytics role including Tableau development
+ 4+ years of experience with SQL
+ 2+ years of experience with Power BI
+ 2+ years of experience with Snowflake
**Preferred Qualifications:**
+ Bachelor's degree in quantitative field such as Statistics, Mathematics, Engineering Finance, Health Administration, or other related field
+ 6+ years of experience in healthcare analytics
+ Experience integrating Python scripts within Tableau using TabPy for advanced calculations and model-driven visualization
+ Risk adjustment experience
+ Knowledge of CMS regulations and Medicare Advantage risk adjustment methodologies such CMS-HCC model (Hierarchical Condition Category), and risk score calculation
+ Proficiency in Power BI, especially in the context of transitioning Tableau reports
+ Strong attention to details and accuracy
+ Strong problem-solving skills and analytical thinking across data visualization, analysis, and reporting.
+ Strong communication and documentation skills to support cross-team collaboration
+ Demonstrated commitment to data accuracy and a strong ability to present data through impactful visual storytelling.
+ Exposure to AI capabilities
+ Expert in Python or R
*All Telecommuters 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 $89,900 to $160,600 annually based on full-time employment. We comply with all minimum wage laws as applicable.
Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records.
**_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._
_UnitedHealth Group 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._
_UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment._
#RPO #GREEN

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start **Caring. Connecting. Growing together.**
You will enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.
**Primary Responsibilities:**
+ Develop and maintain highly optimized Tableau dashboards to support Risk Adjustment reporting and analytics
+ Write and manage efficient, scalable SQL code to support data pipelines and dashboard requirements
+ Perform ad-hoc analysis to support decision-making and business needs across Risk Adjustment initiatives
+ Maintain thorough documentation, including dashboard reference materials and development logs
+ Support the migration of existing reports and dashboards from Tableau to Power BI where needed
+ Troubleshoot data or performance issues related to dashboards and underlying queries
+ Collaborate cross-functionally with clinical, business, and analytics teams to translate requirements into actionable reporting solutions
+ Ensure data accuracy and quality through validation, QA checks, and proactive monitoring
+ Manage the full lifecycle of dashboard development-from requirements gathering to deployment and user support
+ Stay current on CMS Risk Adjustment guidelines to ensure accurate and compliant reporting
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:**
+ High School Diploma/GED (or higher)
+ 4+ years of experience in healthcare analytics role including Tableau development
+ 4+ years of experience with SQL
+ 2+ years of experience with Power BI
+ 2+ years of experience with Snowflake
**Preferred Qualifications:**
+ Bachelor's degree in quantitative field such as Statistics, Mathematics, Engineering Finance, Health Administration, or other related field
+ 6+ years of experience in healthcare analytics
+ Experience integrating Python scripts within Tableau using TabPy for advanced calculations and model-driven visualization
+ Risk adjustment experience
+ Knowledge of CMS regulations and Medicare Advantage risk adjustment methodologies such CMS-HCC model (Hierarchical Condition Category), and risk score calculation
+ Proficiency in Power BI, especially in the context of transitioning Tableau reports
+ Strong attention to details and accuracy
+ Strong problem-solving skills and analytical thinking across data visualization, analysis, and reporting.
+ Strong communication and documentation skills to support cross-team collaboration
+ Demonstrated commitment to data accuracy and a strong ability to present data through impactful visual storytelling.
+ Exposure to AI capabilities
+ Expert in Python or R
*All Telecommuters 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 $89,900 to $160,600 annually based on full-time employment. We comply with all minimum wage laws as applicable.
Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records.
**_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._
_UnitedHealth Group 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._
_UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment._
#RPO #GREEN

At UnitedHealthcare, we're simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and equitable. Ready to make a difference? Join us to start **Caring. Connecting. Growing together.**
We invite you to bring your performance, ideas and innovations to an elite team within a culture built for collaboration. At UnitedHealth Group, we seek individuals who have the ability to drive change, take appropriate risks and influence individuals at all levels of the organization. The Healthcare Economics Consultant within UHC Medicare & Retirement will perform critical investigation of key business problems through quantitative analysis of Medicare Advantage utilization and cost data. The Healthcare Economics Consultant will proactively identify, communicate, and lead organizational dialogue related to healthcare cost/trend opportunities and risks throughout the organization. As a subject matter expert, the Senior Healthcare Economics Consultant will interpret and analyze data from various sources and recommend best approaches to transform the healthcare industry.
You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.
**Primary Responsibilities:**
+ Assist in developing, completing, and communicating the results of studies evaluating the performance of utilization management programs
+ Use SAS/SQL to construct claims-based datasets
+ Construct polished MS Excel models to satisfy analytical requests
+ Understand and interpret key drivers of health care trends (i.e. medical cost trends, utilization, etc.), utilization management program performance, and potential opportunities for medical cost reduction or program improvement
+ Collaborate and develop relationships within the organization including clinical, finance, product, actuarial/underwriting, and operations
+ Provide ongoing, meaningful communications to requestors on project status, results, and conclusions from analyses
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 in statistics, actuarial science, health services research, economics, or a related degree
+ 2+ years analytical experience in financial analysis, data science, actuarial, utilization management program evaluation, or related discipline utilizing highly complex data
+ Proficiency in SQL or/and SAS
+ Proficiency working with formulas, pivots, calculations, charts, graphs in MS Excel
**Preferred Qualifications:**
+ Advanced degree, such as an MPH or MS
+ Experience with Medicare Advantage
+ Experience working with medical claims data.
+ Experience presenting analytical summaries to key stakeholders
+ Proven self-driven, proactivity, and curiosity.
+ Proven advanced interpersonal skills and ability to interact collaboratively with internal customers across multiple departments and business segments
+ Proven advanced verbal and written communication skills
+ Proven solid problem solving and analytical skills
*All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy
**California, Colorado, Connecticut, Hawaii, Nevada, New Jersey, New York, Rhode Island, Washington, Washington, D.C., Maryland Residents Only:** The salary range for this role is $70,200 to $137,800 annually. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable. In addition to your salary, UnitedHealth Group offers 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 UnitedHealth Group, you'll find a far-reaching choice of benefits and incentives.
**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._
_Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law._
_UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment._

Sun Life U.S. is one of the largest providers of employee and government benefits, helping approximately 50 million Americans access the care and coverage they need. Through employers, industry partners and government programs, Sun Life U.S. offers a portfolio of benefits and services, including dental, vision, disability, absence management, life, supplemental health, medical stop-loss insurance, and healthcare navigation. We have more than 6,400 employees and associates in our partner dental practices and operate nationwide.

Visit our website to discover how Sun Life is making life brighter for our customers, partners and communities.

Job Description:

Sun Life embraces a hybrid work model that balances in-office collaboration with the flexibility of virtual work. Internal candidates are not required to relocate near an office.

The opportunity: The Director of Healthcare Economics will support the Health & Risk Solutions business via the Actuarial Pricing team. Primary focus will be pricing PPO Networks, PBMs, TPAs, and measurement of health capability vendor offerings within our Stop-Loss product. This role will work with Distribution, Underwriting, and Health Capabilities teams to identify, manage, and capitalize on viable growth opportunities.

How you will contribute:

• Develop and enhance rate study methodologies
• Establish and maintain effective pricing models for evaluating traditional medical networks
• Identify, evaluate, and monitor new medical network structures (ACOs, reference-based pricing, narrow networks)
• Provide ongoing pricing assessments of administrators and PBMs as well as any associated cost containment programs
• Evaluate impact of external vendors on catastrophic claims and develop strategies to reflect impact in stop-loss pricing
• Lead the development of measurement techniques for health capability offerings
• Proactively search for additional information used to enhance pricing models
• Identify and execute corrective actions as needed to manage pricing for networks, TPAs, PBMs, and other vendors
• Partner with Underwriting, Distribution, and Product Management to identify, support, and grow profitable relationships or fix unprofitable relationships
• Act as a subject matter expert related to network offerings, vendor capabilities, and their associated values to both internal and external partners, including serving as relationship manager on key partnerships
• Proactively identify opportunities to share information with business partners through formal training sessions, internal documentation, etc.
• Provide leadership and direction to Healthcare Economics team, develop and monitor performance of others

What you will bring with you:

• Ability to work with a diverse range of people
• FSA with 7+ years of proven healthcare actuarial experience, stop-loss experience a plus
• Superior analytical, technical, and communication skills
• Ability to deal with imperfect data, and identify supplemental data sources
• Proven ability to navigate and manage ambiguous situations effectively
• Ability to work across different functional areas
• Prior experience with medical networks or provider contracting a plus
• Prior management experience preferred

Salary:

$153,400-$230,100

At our company, we are committed to pay transparency and equity. The salary range for this role is competitive nationwide, and we strive to ensure that compensation is fair and equitable. Your actual base salary will be determined based on your unique skills, qualifications, experience, education, and geographic location. In addition to your base salary, this position is eligible for a discretionary annual incentive award based on your individual performance as well as the overall performance of the business. We are dedicated to creating a work environment where everyone is rewarded for their contributions.

Not ready to apply yet but want to stay in touch? Join our talent community to stay connected until the time is right for you!

We are committed to fostering an inclusive environment where all employees feel they belong, are supported and empowered to thrive. We are dedicated to building teams with varied experiences, backgrounds, perspectives and ideas that benefit our colleagues, clients, and the communities where we operate. We encourage applications from qualified individuals from all backgrounds.

Life is brighter when you work at Sun Life

At Sun Life, we prioritize your well-being with comprehensive benefits, including generous vacation and sick time, market-leading paid family, parental and adoption leave, medical coverage, company paid life and AD&D insurance, disability programs and a partially paid sabbatical program. Plan for your future with our 401(k) employer match, stock purchase options and an employer-funded retirement account. Enjoy a flexible, inclusive and collaborative work environment that supports career growth. We're proud to be recognized in our communities as a top employer. Proudly Great Place to Work Certified in Canada and the U.S., we've also been recognized as a Top 10 employer by the Boston Globe's Top Places to Work for two years in a row. Visit our website to learn more about our benefits and recognition within our communities.

We will make reasonable accommodations to the known physical or mental limitations of otherwise-qualified individuals with disabilities or special disabled veterans, unless the accommodation would impose an undue hardship on the operation of our business. Please email to request an accommodation.

For applicants residing in California, please read our employee California Privacy Policy and Notice.

We do not require or administer lie detector tests as a condition of employment or continued employment.

Sun Life will consider for employment all qualified applicants, including those with criminal histories, in a manner consistent with the requirements of applicable state and local laws, including applicable fair chance ordinances.

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.

Job Category:

Actuarial

Posting End Date:

24/08/2025 #J-18808-Ljbffr

Sun Life U.S. is one of the largest providers of employee and government benefits, helping approximately 50 million Americans access the care and coverage they need. Through employers, industry partners and government programs, Sun Life U.S. offers a portfolio of benefits and services, including dental, vision, disability, absence management, life, supplemental health, medical stop-loss insurance, and healthcare navigation. We have more than 6,400 employees and associates in our partner dental practices and operate nationwide.

Visit our website to discover how Sun Life is making life brighter for our customers, partners and communities.

Job Description:

Sun Life embraces a hybrid work model that balances in-office collaboration with the flexibility of virtual work. Internal candidates are not required to relocate near an office.

The opportunity: The Director of Healthcare Economics will support the Health & Risk Solutions business via the Actuarial Pricing team. Primary focus will be pricing PPO Networks, PBMs, TPAs, and measurement of health capability vendor offerings within our Stop-Loss product. This role will work with Distribution, Underwriting, and Health Capabilities teams to identify, manage, and capitalize on viable growth opportunities.

How you will contribute:

• Develop and enhance rate study methodologies
• Establish and maintain effective pricing models for evaluating traditional medical networks
• Identify, evaluate, and monitor new medical network structures (ACOs, reference-based pricing, narrow networks)
• Provide ongoing pricing assessments of administrators and PBMs as well as any associated cost containment programs
• Evaluate impact of external vendors on catastrophic claims and develop strategies to reflect impact in stop-loss pricing
• Lead the development of measurement techniques for health capability offerings
• Proactively search for additional information used to enhance pricing models
• Identify and execute corrective actions as needed to manage pricing for networks, TPAs, PBMs, and other vendors
• Partner with Underwriting, Distribution, and Product Management to identify, support, and grow profitable relationships or fix unprofitable relationships
• Act as a subject matter expert related to network offerings, vendor capabilities, and their associated values to both internal and external partners, including serving as relationship manager on key partnerships
• Proactively identify opportunities to share information with business partners through formal training sessions, internal documentation, etc.
• Provide leadership and direction to Healthcare Economics team, develop and monitor performance of others

What you will bring with you:

• Ability to work with a diverse range of people
• FSA with 7+ years of proven healthcare actuarial experience, stop-loss experience a plus
• Superior analytical, technical, and communication skills
• Ability to deal with imperfect data, and identify supplemental data sources
• Proven ability to navigate and manage ambiguous situations effectively
• Ability to work across different functional areas
• Prior experience with medical networks or provider contracting a plus
• Prior management experience preferred

Salary:

$153,400-$230,100

At our company, we are committed to pay transparency and equity. The salary range for this role is competitive nationwide, and we strive to ensure that compensation is fair and equitable. Your actual base salary will be determined based on your unique skills, qualifications, experience, education, and geographic location. In addition to your base salary, this position is eligible for a discretionary annual incentive award based on your individual performance as well as the overall performance of the business. We are dedicated to creating a work environment where everyone is rewarded for their contributions.

Not ready to apply yet but want to stay in touch? Join our talent community to stay connected until the time is right for you!

We are committed to fostering an inclusive environment where all employees feel they belong, are supported and empowered to thrive. We are dedicated to building teams with varied experiences, backgrounds, perspectives and ideas that benefit our colleagues, clients, and the communities where we operate. We encourage applications from qualified individuals from all backgrounds.

Life is brighter when you work at Sun Life

At Sun Life, we prioritize your well-being with comprehensive benefits, including generous vacation and sick time, market-leading paid family, parental and adoption leave, medical coverage, company paid life and AD&D insurance, disability programs and a partially paid sabbatical program. Plan for your future with our 401(k) employer match, stock purchase options and an employer-funded retirement account. Enjoy a flexible, inclusive and collaborative work environment that supports career growth. We're proud to be recognized in our communities as a top employer. Proudly Great Place to Work Certified in Canada and the U.S., we've also been recognized as a Top 10 employer by the Boston Globe's Top Places to Work for two years in a row. Visit our website to learn more about our benefits and recognition within our communities.

We will make reasonable accommodations to the known physical or mental limitations of otherwise-qualified individuals with disabilities or special disabled veterans, unless the accommodation would impose an undue hardship on the operation of our business. Please email to request an accommodation.

For applicants residing in California, please read our employee California Privacy Policy and Notice.

We do not require or administer lie detector tests as a condition of employment or continued employment.

Sun Life will consider for employment all qualified applicants, including those with criminal histories, in a manner consistent with the requirements of applicable state and local laws, including applicable fair chance ordinances.

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.

Job Category:

Actuarial

Posting End Date:

14/09/2025 #J-18808-Ljbffr