Associate Director, Economics - Medex​/Datawarehouse - Remote

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Under executive direction, the Associate Director Medex/DW Healthcare Economics Optum Massachusetts is responsible for all aspects of assessing, evaluating, and estimating outside medical expenses and claims data warehouse for Optum Massachusetts. Responsible for complex trend analysis and reporting to inform senior management's decision making regarding the level of changes for financial statement reporting. Makes recommendations and provides critical professional expertise to inform senior management of amounts to record in the financial statements.

Assesses and ensures the integrity, accuracy and consistency of the financial and utilization reports and databases and leads action plans for making improvements. Manages staff, consisting primarily of financial analysts. As the accountable business owner, oversees the implementation of changes to the databases, reports, and processes as dictated by changes in business needs to support the recording of outside medical expenses in the financial statements.

You'll enjoy the flexibility to work remotely
* from anywhere within the U.S. as you take on some tough challenges. For all hires in the Minneapolis or Washington, D.C. area, you will be required to work in the office a minimum of four days per week.

• Oversee all aspects of calculation of outside claims expense and related reserves under hospital and payer risk contracts. Has overall responsibility for monthly calculation of expenses, liabilities, and accounts receivable related to payer risk contracts
• Manages the monthly process of outside medical expense projections, the population of reporting and analytic databases, and the required reporting and analysis of inpatient and outside utilization expenses
• Performs the monthly analytic review and interprets enterprise-wide, and site specific, trends and variances. Based on this analysis, makes critical recommendations to leadership on amounts to record in the monthly financial statements. Develop new financial and utilization reports and analyses as needed
• Supporting all amounts recorded by accounting and ensuring that proper financial controls are in place to verify amounts recorded
• Partners with business leaders and build solid relationships in support of financial performance; acts as a strategic thought-partner for the business
• Drives intersegment agreements between Optum Massachusetts and UHC entities along with understanding the financial impacts
• Responsible for: quarterly forecasts of all outside medical expense accounts, and related deliverables (i.e, bridges, trend reporting, supplemental schedules as applicable);
  Atrius forecast model for medical expense rates; creation of trends to ascertain year over year changes, experience, etc.
• Partners across Optum Massachusetts Finance team to help lead integration activities
• Manages the monthly preparation of complex payer medical expense trend analyses for discussion at monthly financial statement meetings
• Provides recommendations on inpatient and outside utilization expense levels and directs the creation of monthly journal entry to record outside medical cost
• Develops and maintains on-going relationships with outside providers, payers and other external parties regarding data feeds, outside provider discounts and reinsurance issues. Directs the calculations and reconciliations of risk-sharing settlements with payers and hospitals. Has responsibility for contractually required medical claims expense and utilization reporting under risk-sharing arrangements with hospitals
• Works directly with the actuaries and outside auditors on evaluation of the sufficiency of recording for hospital and outside utilization expense. As an expert, provides detailed support to auditors for the purpose of their actuarial assessments. Monitors amounts recorded against claims 'run out'. Works with financial auditors to validate medical claims expense and liabilities under payer and hospital risk contract/risk-sharing arrangements
• In the business owner role, contact payers to enable the data warehouse to be populated with accurate and correct data. has responsibility for the calculation and monitoring of claims liability reserves from prior years' risk arrangements
• Provides financial expertise and…