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Enlace Health is a specialty value-based care company operating across 80+ markets, helping payors reduce medical loss ratios and improve care coordination through actionable intelligence embedded in real-world execution.
As Senior Medical Economics Analyst, you will leverage deep expertise in actuarial methods, value-based payment modeling, predictive analytics, and medical cost economics to support the design, evaluation, and optimization of value-based pricing and performance frameworks across Commercial, Medicare Advantage, and Medicaid populations.
Key responsibilities include:
- Support pricing validation, reconciliation modeling, and performance evaluation analyses
- Construct prospective and retrospective target-setting methodologies using difference-in-differences approaches, market benchmarking, credibility weighting, and risk-adjusted baselines
- Evaluate financial and quality performance across Commercial, Medicare Advantage, and Medicaid lines of business
- Develop and operationalize predictive models for cost, utilization, quality outcomes, and performance evaluation
- Support steerage, network optimization, and care management analytics
- Perform medical cost trend decomposition (unit cost vs. utilization vs. intensity vs. mix)
- Conduct risk-adjusted PMPM analysis across specialties, site-of-service, and population segments
- Analyze longitudinal performance across defined assessment periods
- Quantify impact of specialty utilization patterns and referral dynamics
- Evaluate acuity, case-mix, and coding impacts across populations
- Write advanced SQL queries to construct episode-level, provider-level, and member-month datasets
Success milestones: In 3 months, gain command of data and methodologies while delivering validated insights. In 6 months, translate analytics into actionable financial and clinical insights and own development of evaluation methodologies. In 12 months, architect scalable value-based pricing frameworks and demonstrate measurable enterprise impact on cost, quality, and risk performance.
Required qualifications: Bachelor's degree in STEM field (Master's preferred) or equivalent work experience; 5+ years in payer, provider, or healthcare analytics organizations; demonstrated experience across Commercial, Medicare, and Medicaid populations; deep experience with medical claims data, enrollment/eligibility data, provider data, CMS revenue and risk adjustment data, and value-based performance datasets; strong proficiency in SQL, Tableau, and Excel; Python or R experience is a plus.
