Manager, Medical Economics

Key Responsibilities

• Lead the end-to-end membership reconciliation process, ensuring that enrollment, eligibility, and capitation payments are accurately tracked and reconciled across payer files, internal systems, and the general ledger.
• Investigate and resolve membership and premium variances, including retroactive additions, terminations, and rate changes.
• Quantify revenue at risk and collaborate with internal teams and health plans to recover discrepancies.
• Build and maintain business rules, controls, and data flows supporting member-month counts and premium accrual processes.
• Partner with Finance, Operations, and EIM teams to identify root causes and implement upstream data improvements.
• Produce monthly reconciliation reports and dashboards to give leadership visibility into membership, PMPM, and premium trends.
• Support month-end close activities by validating premium revenue and explaining membership and premium variances.
• Conduct independent analyses and present findings and recommendations to leadership.
• Design scalable reconciliation processes and prepare to support the growth of an analyst team.

Qualifications

Required

• Bachelor’s degree in Statistics, Mathematics, Economics, Computer Science, Healthcare Management, or a related field.
• 7+ years of experience in healthcare analytics, medical economics, or premium/membership reconciliation.
• Experience with healthcare, managed care, health plans, value-based care organizations, or healthcare analytics environments.
• Strong expertise in Medicare Advantage, healthcare analytics, and/or medical economics.
• In-depth understanding of healthcare financial concepts, including PMPM, member months, capitation, premium accrual, and eligibility.
• Experience with enrollment and eligibility data, including payer files such as 834/820 transactions.
• Advanced Excel proficiency and the ability to independently analyze complex datasets.
• Ability to present analytical findings and recommendations to leadership.
• Strong analytical, problem-solving, communication, and relationship-building skills.

Preferred

• Experience with SQL.
• Experience in premium reconciliation processes.
• Managed care organization experience.
• Experience building dashboards in Power BI or Tableau.
• Knowledge of value-based care analytics and risk-based reimbursement models.
• Previous leadership or team management experience.