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Medical Economics Senior Analyst
Massgeneralbrigham · Somerville-MA
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Other (Adjacent or hard to classify.)
posted
1d ago
location
Somerville-MA
languages
sql
tools
excel
> stack
sqlexcel
> description
Site: Mass General Brigham Health Plan Holding Company, Inc.
Our work centers on creating an exceptional member experience – a commitment that starts with our employees. Working with some of the most accomplished professionals in healthcare today, our employees have opportunities to learn and contribute expertise within a welcoming and supportive environment that embraces their unique and varied backgrounds, experiences, and skills.
We are pleased to offer competitive salaries and a benefits package with flexible work options, career growth opportunities, and much more.
The Medical Economics Senior Analyst oversees the design, development, and delivery of regulatory reports and financial analyses that support Mass General Brigham Health Plan’s external filings and internal interpretation of results. This role requires expertise in financial regulatory reporting. Hands-on experience with Center for Health Information and Analysis (CHIA), Division of Insurance (DOI), and Center for Medicare and Medicaid Services (CMS) submissions is strongly preferred.
The Senior Analyst translates complex regulatory specifications into actionable data logic, ensures accurate and timely report production, and identifies key drivers of cost, utilization, and performance. In addition to independently executing complex analyses, the Senior Analyst helps guide and develop junior staff in the design, programming, validation, and documentation of reporting workflows.
This role partners closely with Actuarial, Finance, Provider Network Management (PNM), Pharmacy, and Product teams to support a broad regulatory portfolio, including CHIA submissions (e.g., Premium, Relative Price, Total Medical Expenses, and Alternative Payment Methods (TME-APM), Primary Care and Behavioral Health (PC-BH), DOI utilization reporting, Pharmacy Rebate, and RxDC filings. The Senior Analyst also serves as the subject matter expert for regulatory reporting, ensuring consistency, audit readiness, and alignment with evolving regulatory requirements.
Essential Functions
-Translate complex regulatory specs into executable data logic, including mapping business definitions to claims, enrollment, pharmacy, and provider data sources.
-Own end-to-end reporting lifecycle: requirements intake, data extraction, transformation, validation, and submission support across recurring annual, quarterly, and monthly filings.
-Execute and enhance reporting workflows for key filings such as CHIA Pharmacy Rebate, RxDC, Premium, Relative Price, Total Medical Expenses and Alternative Payment Methods (TME-APM), Primary Care and Behavioral Health (PC-BH), and DOI utilization reports.
-Develop and maintain reusable code, parameterized logic, and standardized datasets to support repeatable reporting processes.
-Perform rigorous data validation, including reconciliation to prior submissions, financial systems, and BI tools to ensure accuracy and audit readiness.
-Document reporting processes at varying levels of maturity (checklist, step-by-step instructions, and comprehensive guides) to support continuity and scalability.
-Partner cross-functionally with Actuarial, Finance, Product, Pharmacy, and Network teams to source inputs, validate outputs, and resolve data gaps.
-Support internal reporting needs alongside external regulatory deliverables.Remote399 Revolution Drive40RegularDay (United States of America)8925 Mass General Brigham Health Plan Holding Company, Inc. is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religious creed, national origin, sex, age, gender identity, disability, sexual orientation, military service, genetic information, and/or other status protected under law. We will ensure that all individuals with a disability are provided a reasonable accommodation to participate in the job application or interview process, to perform essential job functions, and to receive other benefits and privileges of employment. To ensure reasonable accommodation for individuals protected by Section 503 of the Rehabilitation Act of 1973, the Vietnam Veteran’s Readjustment Act of 1974, and Title I of the Americans with Disabilities Act of 1990, applicants who require accommodation in the job application process may contact Human Resources at (857)-282-7642.
Mass General Brigham relies on a wide range of professionals, including doctors, nurses, business people, tech experts, researchers, and systems analysts to advance our mission. As a not-for-profit, we support patient care, research, teaching, and community service, striving to provide exceptional care. We believe that high-performing teams drive groundbreaking medical discoveries and invite all applicants to join us and experience what it means to be part of Mass General Brigham.
Job Summary
Mass General Brigham Health Plan is an exciting place to be within the healthcare industry. As a member of Mass General Brigham, we are at the forefront of transformation with one of the world’s leading integrated healthcare systems. Together, we are providing our members with innovative solutions centered on their health needs to expand access to seamless and affordable care and coverage.Our work centers on creating an exceptional member experience – a commitment that starts with our employees. Working with some of the most accomplished professionals in healthcare today, our employees have opportunities to learn and contribute expertise within a welcoming and supportive environment that embraces their unique and varied backgrounds, experiences, and skills.
We are pleased to offer competitive salaries and a benefits package with flexible work options, career growth opportunities, and much more.
The Medical Economics Senior Analyst oversees the design, development, and delivery of regulatory reports and financial analyses that support Mass General Brigham Health Plan’s external filings and internal interpretation of results. This role requires expertise in financial regulatory reporting. Hands-on experience with Center for Health Information and Analysis (CHIA), Division of Insurance (DOI), and Center for Medicare and Medicaid Services (CMS) submissions is strongly preferred.
The Senior Analyst translates complex regulatory specifications into actionable data logic, ensures accurate and timely report production, and identifies key drivers of cost, utilization, and performance. In addition to independently executing complex analyses, the Senior Analyst helps guide and develop junior staff in the design, programming, validation, and documentation of reporting workflows.
This role partners closely with Actuarial, Finance, Provider Network Management (PNM), Pharmacy, and Product teams to support a broad regulatory portfolio, including CHIA submissions (e.g., Premium, Relative Price, Total Medical Expenses, and Alternative Payment Methods (TME-APM), Primary Care and Behavioral Health (PC-BH), DOI utilization reporting, Pharmacy Rebate, and RxDC filings. The Senior Analyst also serves as the subject matter expert for regulatory reporting, ensuring consistency, audit readiness, and alignment with evolving regulatory requirements.
Essential Functions
-Translate complex regulatory specs into executable data logic, including mapping business definitions to claims, enrollment, pharmacy, and provider data sources.
-Own end-to-end reporting lifecycle: requirements intake, data extraction, transformation, validation, and submission support across recurring annual, quarterly, and monthly filings.
-Execute and enhance reporting workflows for key filings such as CHIA Pharmacy Rebate, RxDC, Premium, Relative Price, Total Medical Expenses and Alternative Payment Methods (TME-APM), Primary Care and Behavioral Health (PC-BH), and DOI utilization reports.
-Develop and maintain reusable code, parameterized logic, and standardized datasets to support repeatable reporting processes.
-Perform rigorous data validation, including reconciliation to prior submissions, financial systems, and BI tools to ensure accuracy and audit readiness.
-Document reporting processes at varying levels of maturity (checklist, step-by-step instructions, and comprehensive guides) to support continuity and scalability.
-Partner cross-functionally with Actuarial, Finance, Product, Pharmacy, and Network teams to source inputs, validate outputs, and resolve data gaps.
-Support internal reporting needs alongside external regulatory deliverables.
Qualifications
Education
- Bachelor's Degree required; experience can be considered in lieu of a degree
Experience
- At least 5-7 years of experience in data analysis required
- Experience running CHIA Pharmacy Rebate, RxDC, Premium, Relative Price, Total Medical Expenses and Alternative Payment Methods (TME-APM), Primary Care and Behavioral Health (PC-BH), and DOI utilization reports is highly preferred
Knowledge, Skills, and Abilities
- Strong knowledge of relational databases, SQL, data visualization, and Business Intelligence tools, such as Tableau.
- Strong proficiency with Microsoft Office Suite, including Word, Excel, and PowerPoint.
- Ability to communicate complex workflows and data to a variety of audiences.
- Project management skills and/or experience are a plus.
- Knowledge and application of statistical analyses, including variance analysis and statistical significance preferred.
- Healthcare knowledge, particularly as it pertains to electronic medical record data, is preferred but not required.
Additional Job Details (if applicable)
Working Conditions
- This is a remote role that can be done from most US states
- Schedule is Monday through Friday, 8:30 AM - 5:00 PM Eastern
- Employees must use a stable, secure, and compliant workstation in a quiet environment. Teams video is required and must be accessed using MGB-provided equipment.
Remote Type
Work Location
Scheduled Weekly Hours
Employee Type
Work Shift
Pay Range
$79,560.00 - $115,720.80/Annual
Grade
7
EEO Statement:
Mass General Brigham Competency Framework
At Mass General Brigham, our competency framework defines what effective leadership “looks like” by specifying which behaviors are most critical for successful performance at each job level. The framework is comprised of ten competencies (half People-Focused, half Performance-Focused) and are defined by observable and measurable skills and behaviors that contribute to workplace effectiveness and career success. These competencies are used to evaluate performance, make hiring decisions, identify development needs, mobilize employees across our system, and establish a strong talent pipeline.