Sanford Health is an integrated healthcare and health insurance system serving communities across America’s heartland. Headquartered in Sioux Falls, South Dakota, it supports more than 1.4 million patients and nearly 200,000 health plan members through a broad network of medical centers, clinics, senior living communities, physicians, and advanced practice providers. Its work spans direct patient care, insurance, clinical research, and personalized genetic medicine, with specialized programs in areas including cancer, orthopedics, women’s health, and genetics.
Medical Economics Analyst, Health Plan
Analyze claims, pharmacy, and healthcare cost data for Sanford Health’s rural health system. Build models and insights to support health plan performance.
Description
- Review medical claims, pharmacy, and other healthcare data to identify cost and utilization trends, patterns, and outliers.
- Model the financial effects of clinical programs, initiatives, and value-based agreements.
- Find medical cost reduction opportunities, estimate potential savings, and assess the return on implemented initiatives.
- Build reports, dashboards, and presentations with data visualization tools.
- Share findings and practical insights with senior leaders and clinical departments.
- Work with accounting, actuarial, underwriting, clinical, health services delivery, and network management teams.
- Support decisions and strategic planning, including payer negotiations and risk adjustment strategies.
- Check the accuracy and integrity of data used in analyses.
- Document project methods and key decision points.
- Handle ad hoc data analysis requests from departments across the organization.
Requirements
- Bachelor’s degree in economics, statistics, finance, public health, mathematics, actuarial science, data analytics, or a related quantitative field.
- One to three years of progressive analytical experience in healthcare, such as health insurance, managed care, or a health system.
- Knowledge of STARS and risk adjustment preferred.
- Strong analytical, problem-solving, critical-thinking, and communication skills.
- Proficiency with SQL for data extraction and manipulation.
- Advanced Microsoft Excel skills, including pivot tables and complex formulas.
- Experience with data visualization tools such as Tableau or Power BI is highly valued.
- Familiarity with statistical tools such as SAS, R, or Python is a plus.