Job Description

Company Overview:

Upward Health is an in-home, multidisciplinary medical group providing 24/7 whole-person care. Our clinical team treats physical, behavioral, and social health needs when and where a patient needs help. Everyone on our team from our doctors, nurses, and Care Specialists to our HR, Technology, and Business Services staff are driven by a desire to improve the lives of our patients. We are able to treat a wide range of needs everything from addressing poorly controlled blood sugar to combatting anxiety to accessing medically tailored meals because we know that health requires care for the whole person. Its no wonder 98% of patients report being fully satisfied with Upward Health!

Job Title & Role Description:

The Medical Economics Analyst will be a key member of the finance and analytics team, supporting the organizations value-based care strategy through data-driven insight. This role will analyze medical claims, utilization trends, and financial performance to help quantify the impact of clinical programs and inform contract strategy with payers and partners.

This is an excellent opportunity for a detail-oriented and driven professional with a passion for healthcare and strong analytical skills to grow within a dynamic and mission-driven organization.

Responsibilities:

• Analyze total cost of care (TCOC), utilization, and quality trends across Upward Health populations
• Support financial impact modeling for value-based initiatives, including ER diversion, home-based care, and chronic care management
• Identify cost drivers and areas of opportunity using claims, clinical, and operational data
• Develop methodologies to assess return on investment (ROI) of clinical interventions
• Partner with clinical, finance, and contracting teams to inform payor negotiations and risk adjustment strategy
• Produce recurring dashboards and ad hoc analyses for senior leadership, clinical leadership, and health plan partners
• Support budgeting and forecasting for risk-based contracts
• Collaborate with actuaries and population health teams to refine attribution, benchmarks, and risk scores

Skills Required:

• Technical Proficiency:
  • Advanced Excel and SQL skills required.
  • Proficiency in data visualization tools such as Tableau, Power BI, or QlikView.
  • Experience with statistical tools such as SAS, R, or Python preferred.
• Data Analysis:
  • Strong knowledge of healthcare claims data (medical, pharmacy, eligibility).
  • Ability to conduct cost/utilization analysis, trend analysis, and predictive modeling.
  • Experience working with Medicare Advantage, Medicaid Managed Care, or Dual Eligible populations.
  • Familiarity with CMS HCC risk adjustment models and RAF score analysis
  • Exposure to actuarial methods, including trend normalization or IBNR estimation.
• Communication:
  • Ability to translate complex data into actionable insights.
  • Strong written and verbal communication skills for presenting to stakeholders.
• Project Management:
  • Experience managing multiple priorities and meeting deadlines in a fast-paced environment.

Key Behaviors:  

• Analytical Rigor
  • Demonstrates strong critical thinking and problem-solving skills.
  • Uses data to drive decisions and remains objective when interpreting findings.
• Attention to Detail
  • Ensures accuracy in data analysis, coding, and reporting.
• Collaboration
  • Works effectively with cross-functional teams including finance, clinical, IT, and operations.
• Initiative
  • Proactively identifies opportunities for improvement or cost containment.
• Adaptability
  • Comfortable working in a fast-paced and changing healthcare environment.
• Integrity and Confidentiality
  • Maintains high ethical standards, especially when dealing with sensitive patient and financial data.
• Business Acumen:
  • Understanding of managed care, value-based care, and healthcare reimbursement models.

Competencies:

• Healthcare Industry Knowledge: Solid understanding of the healthcare ecosystem, including payers, providers, and regulatory frameworks.
• Quantitative Analysis: Expertise in statistical and financial analysis, particularly related to healthcare cost and utilization.
• Problem Solving: Ability to identify root causes of complex issues and recommend practical solutions.
• Data Management: Skilled in extracting, cleaning, and structuring large datasets from multiple sources.
• Strategic Insight: Capable of connecting analysis to business goals and influencing organizational strategy.

Qualifications

• Bachelors degree in economics, public health, healthcare administration, finance, statistics, or a related field; Masters preferred (MPH, MHA, MS, MBA)
• 2+ years of experience in medical economics, healthcare analytics, or population health analysis; provider-side experience strongly preferred
• Proficiency with healthcare claims data and common file formats (837, 835, encounter data)
• Skilled in SQL, Excel, and at least one analytics tool (e.g., Tableau, Power BI, R, or Python)
• Understanding of value-based payment models, including shared savings, capitation, and risk adjustment
• Strong business acumen with the ability to present complex data clearly and actionably
• Ability to thrive in a fast-paced, mission-driven organization

Upward Health is proud to be an equal opportunity employer. We are committed to attracting, retaining, and maximizing the performance of a diverse and inclusive workforce. This job description is a general outline of duties performed and is not to be misconstrued as encompassing all duties performed within the position.

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