Analytics Manager ( Healthcare insurance claims )

Experience: 7 Years to 17 years

Position Summary

The International Health Medical Economics team is looking for a Medical Economics

Analytics Manager to help identify the drivers of medical cost and utilization trends and

translate them into actions that improve affordability and health outcomes. This role

combines healthcare claims expertise, advanced analytics, data visualization, and

stakeholder leadership. The successful candidate will lead a team responsible for analysing

complex claims and eligibility data, identifying actionable opportunities, and partnering with

Network, Clinical, and Fraud, Waste and Abuse teams to develop targeted interventions.

The role is suited to an analytics leader who can move from data exploration and root-cause

analysis to executive communication, recommended interventions, and measurable

business action.

Responsibilities

Claims analytics and insight generation

 Lead analysis of medical cost and utilization trends to identify underlying drivers

across markets, clients, providers, populations, and clinical categories.

 Apply healthcare claims knowledge to distinguish the effects of utilization, unit cost,

provider mix, service mix, disease burden, benefit design, and member behaviour.

 Develop analytics covering provider performance, population risk, claims leakage,

clinical variation, and potential fraud, waste and abuse.

 Convert analytical findings into clearly defined opportunities, supported by evidence,

expected impact, and recommended next actions.

Business action and stakeholder partnership

 Partner with Network teams to support provider benchmarking, contracting

strategies, and provider negotiations.

 Partner with Clinical teams to identify opportunities related to care pathways, disease

management, utilization management, and site-of-care optimization.

 Partner with FWA teams to identify abnormal billing, utilization, and provider

behaviour patterns requiring further investigation.

 Present complex analytical findings to senior stakeholders in a concise, decision-

oriented format.

 Track whether implemented actions deliver the expected impact and use the results

to improve future analyses.

Analytics products and dashboards

 Define and develop self-service dashboards that enable users to identify and

investigate medical cost and utilization drivers more quickly.

 Translate business questions into analytical requirements, measures, drill-down

pathways, and intuitive dashboard designs.

 Work with Data and Technology teams to ensure analytics products are scalable,

reliable, and supported by appropriate data controls.

Team and capability leadership

 Lead, coach, and develop a team of analysts and data specialists.

 Set analytical priorities based on business value, feasibility, and stakeholder needs.

 Review analytical approaches and outputs to ensure accuracy, consistency, and

actionability.

 Collaborate with actuarial, finance, data, and analytics teams to reuse existing

capabilities and avoid duplication.

Qualifications

 10+ years of experience in health insurance claims analytics, medical economics,

actuarial analytics, or health insurance consulting, including experience leading

analytical projects or teams

 Strong understanding of healthcare claims data, including diagnosis, procedure,

provider, place-of-service, utilization, unit-cost, and member-level information

 Experience using a visualization platform such as Qlik Sense, Power BI, or Tableau

 Hands-on proficiency in SQL and experience working with large, complex claims

datasets

 Strong written, verbal, presentation, and stakeholder-management skills