Medical Cost Analytics Senior Manager; Remote

The Payment Integrity & Affordability Governance organization partners across the enterprise to deliver insights that help reduce healthcare costs, improve outcomes, and strengthen financial sustainability. Our work supports both internal and external partners by translating complex data into clear, actionable strategies. The Payment Integrity Analytics Team focuses on measurement and analytics for national Payment Integrity programs—helping leaders understand the future strategy and current program performance including what’s working, where opportunities exist, and how we can continue to improve affordability and customer experience at scale.

As a Senior Manager, you’ll lead a team of analysts supporting Payment Integrity initiatives. This role blends healthcare data analytics and AI, financial insight, and people leadership, with a strong emphasis on influencing decisions at the executive level. The role will also be responsible for comprehensively looking at the provider and payer landscape to identify and drive innovative approaches for understanding medical cost trends, provider behavior, provider billing behavior, and healthcare industry operations to streamline medical costs for health plan members.

This role will partner closely with stakeholders across finance, operations, clinical, product and network teams to evaluate trends, support proposals, and ensure accurate financial measurement for new programs and initiatives. This is an ideal role for a leader who enjoys connecting strategy to execution—and who wants their work to directly impact healthcare affordability.

• Lead strategic analytics by identifying medical cost drivers and trends, risks, and affordability opportunities.
• Develop and execute analysis and AI to support Payment Integrity strategies at the enterprise level driving alignment across various business unites to ensure enterprise financial goals & priorities.
• Tell the story behind the data, translating analytical findings into clear, executive‑ready insights that influence decisions across technical, operational, and senior leadership audiences.
• Own financial business cases for new affordability initiatives, including forecasts, variance analysis, and recommendations to improve performance.
• Support Payment Integrity by overseeing analytics for initiatives, policy changes, and ongoing performance monitoring.
• Improve reporting and visualization by assessing current capabilities and advancing self‑service analytics solutions, utilizing AI to optimize quality, accuracy and reporting (e.g., Databricks, Tableau, Claude, Cursor or similar tools).
• Modernize analytics through scalable methods, automation, and thoughtful use of AI‑enabled tools where they add value.
• Monitors and conducts research of related affordability, AI, business trends, using data and qualitative performance measures, to advise senior management relative to Payment Integrity strategy.
• Manage and develop a team of analysts, setting clear priorities, ensuring high‑quality output, and supporting continuous skill development.
• Balance multiple initiatives by prioritizing and delegating work effectively in a fast‑paced, dynamic environment.
• Ensure data quality and accuracy by implementing appropriate checks, controls, and processes.
• Act as a trusted thought partner to senior leaders by proactively identifying insights, risks, and emerging trends that inform near‑and long‑term affordability strategy.

• Proven ability to translate complex analyses into actionable business insights.
• Clear, confident communication skills with experience presenting to senior and executive audiences.
• Demonstrated success managing multiple priorities and leading teams in a matrixed environment.
• A…