Your Role The healthcare economics team devises strategies and supports work to make healthcare affordable through data analysis, cost of healthcare modeling and economic forecasting in a healthcare environment. The medical informatics senior health care economics reports to the senior manager of healthcare economics. The role includes developing insights into healthcare costs, trends, utilization and risks to support strategic decision making.
Your Work
In this role, you will:
- Collect and evaluate data, develop and maintain financial models, analyze results and conduct scenario analyses to estimate cost of healthcare savings and to support cost /benefit analyses to understand the relative benefits of alternative courses of action
- Reconcile data results from different sources and combine them into integrated reports spanning cost, quality, utilization, and risk profile metrics
- Participate in internal workgroups and committees to provide analytical insight and support for the implementation and enhancement of new programs, products, and services
- Collaborate with key operational leaders to establish credible assumptions to support modeling of proposed initiatives to mitigate cost of healthcare trend while maintaining/improving the quality of care
- Analyze data to identify opportunities to improve healthcare quality, reduce costs and enhance member outcomes
- Use AI to gain efficiency around analyzing data, getting insights and creating reporting and presentations
- Present complex actuarial and economic insights to executive leadership and key stakeholders in a clear, actionable manner
- Use deep understanding of underlying business requirements to conceptualize and develop analytical systems that meet important business needs
- Coordinate activities with other internal departments to maximize overall efficiency and resolve conflicts
- Communicate project status, progress, and outcomes to executive management
Your Knowledge and Experience
- Requires a bachelor’s degree or High School Diploma/GED and 4 years of additional relevant experience in lieu of a degree
- Requires 5 years of prior relevant experience
- Prefer at least 5 years of experience in Health Care (managed care, academic, or gov't payer)
- Requires advanced knowledge of healthcare data and managed health plan operations
- Requires strong analytic and problem-solving skills with proficiency in data analysis tools
- Requires excellent communication and presentation skills with the ability to convey complex information to executive leadership and other stakeholders
- Requires ability to deliver moderate-complexity analyses using 3–4 data sources across 3–4 clinical areas, including univariate methods and standard statistical graphics
- Requires experience supporting high-complexity analyses using 5 or more data sources and multivariate methods with cross-department coordination
- Requires the ability to develop production code in SQL/PL-SQL and SAS Base (or equivalent) and produce repeatable reporting outputs in Excel and/or Power BI
- Requires experience using AI to summarize and analyze data, gather insights into data, and create reporting and presentations
Hybrid This role requires employees to be in-office based on our hybrid workplace model, balancing purposeful in-person collaboration with flexibility. For most teams, this means coming into the office two days each week.
Employees living more than 50 miles from an office location will work with their manager to determine in-office time based on business need.
About Blue Shield of California
As of January 2025, Blue Shield of California became a subsidiary of Ascendiun. Ascendiun is a nonprofit corporate entity that is the parent to a family of organizations including Blue Shield of California and its subsidiary, Blue Shield of California Promise Health Plan; Altais, a clinical services company; and Stellarus, a company designed to scale healthcare solutions. Together, these organizations are referred to as the Ascendiun Family of Companies.
At Blue Shield of California, our mission is to create a healthcare system worthy of our family and friends and sustainably affordable. We are transforming health care in a way that genuinely serves our nonprofit mission by lowering costs, improving quality, and enhancing the member and physician experience.
To achieve our mission, we foster an environment where all employees can thrive and contribute fully to address the needs of the various communities we serve. We are committed to creating and maintaining a supportive workplace that upholds our values and advances our goals.
Blue Shield is a U.S. News Best Company to work for, a Deloitte U.S. Best Managed Company and a Top 100 Inspiring Workplace. We were recognized by Fair360 as a Top Regional Company, and one of the 50 most community-minded companies in the United States by Points of Light. Here at Blue Shield, we strive to make a positive change across our industry and communities – join us!
Our Values:
- Honest. We hold ourselves to the highest ethical and integrity standards. We build trust by doing what we say we're going to do and by acknowledging and correcting where we fall short.
- Human. We strive to listen and communicate effectively, showing empathy by understanding others' perspectives.
- Courageous. We stand up for what we believe in and are committed to the hard work necessary to achieve our ambitious goals.
Our Workplace Model
We believe in fostering a workplace environment that balances purposeful in-person collaboration with flexibility - providing clear expectations while respecting the diverse needs of our workforce. Our workplace model is designed around intentional in-person interaction, collaboration, connection, creativity and flexibility:
• For most teams, this means coming into the office two days per week.
• Employees living more than 50 miles from an office location, out of state employees, and employees in certain member-facing roles should work with their manager to determine in-office time based on business need.
• For employees with medical conditions that may impact their ability to work in-office, we are committed to engaging in an interactive process and providing reasonable accommodations to ensure their work environment is conducive to their success and well-being.
The Company reserves the right to require more presence in the office based on business needs, and requirements are subject to change with periodic reviews.
Physical Requirements:
Office Environment - roles involving part to full time schedule in Office Environment. Based in our physical offices and work from home office/deskwork - Activity level: Sedentary, frequency most of work day.
Please click here for further physical requirement detail.
Equal Employment Opportunity:
External hires must pass a background check/drug screen. Qualified applicants with arrest records and/or conviction records will be considered for employment in a manner consistent with Federal, State and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regards to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or disability status and any other classification protected by Federal, State and local laws.