Site: Mass General Brigham Health Plan Holding Company, Inc.
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 on the forefront of transformation with one of the world’s leading integrated healthcare systems. Together, we provide our members—across Commercial, Medicare Advantage, and Medicare‑Medicaid Dual Eligible (Duals) products—with innovative, high‑quality, and affordable care.
Our work centers on creating an exceptional member experience supported by rigorous medical economics and data‑driven decision‑making. Employees collaborate with accomplished healthcare professionals in a consciously inclusive environment where diversity is celebrated.
The Senior Healthcare Analyst provides value‑added analytic support in the development and monitoring of standard and ad hoc medical cost and utilization reporting for the health plan’s Medicare Advantage and Dual Eligible populations. As part of this work, the analyst independently designs and performs complex analyses with enterprise‑level impact.
Primary Responsibilities:
Cost and Utilization:
Participates in the development and ongoing enhancement of medical cost and utilization analysis and reporting across Medicare Advantage and Dual Eligible lines of business.
Analyzes and interprets utilization and medical expense data; identifies key drivers including risk mix, Stars‑related utilization, and site of care; performs drill‑down analyses; and presents findings to leadership.
Works with clinical, finance, and operations partners to ensure accurate capture, interpretation, analysis, and reporting of claims, encounters, and authorization data in alignment with CMS requirements.
Supports enterprise trend management activities by monitoring emerging utilization and unit cost trends, identifying variance drivers against expectations, and partnering with clinical, finance, and operations leaders to inform mitigation strategies and performance management.
Partners with clinical, finance, operations, and other teams to support the delivery of regulatory reporting, provider reporting, and related analytic requests, including Medicare Advantage and Dual Eligible reporting requirements; ensure analyses are accurate, auditable, and aligned with CMS, internal governance, and external stakeholder needs.
Clinical Program Evaluation:
Drives the development of pro