Manage, analyze, and report medical and pharmacy claims to identify cost drivers, utilization trends, and opportunities to optimize benefit design and vendor performance.Develop trend analyses and forecasting models to support healthcare cost projections, budgeting, and scenario planning.Apply industry knowledge and data analysis to identify inefficiencies, cost drivers, and performance gaps and recommend strategies to improve spend while protecting member outcomes.Conduct benchmarking analyses to assess the competitiveness of benefit programs and identify gaps and opportunities for improvement.Evaluate and recommend benefit design changes (e.g., medical, dental, vision, disability, life insurance) to support effective plan management, cost efficiency, and a strong employee experience.Define key financial, clinical, and utilization metrics to assess health plan performance and establish reporting to monitor those indicators.Facilitate internal Chief Medical Officer involvement through regular updates and escalation of material clinical, utilization, or cost trends, as needed.Support evaluation of clinical programs, including case management initiatives and related vendor partnerships, to assess impact on health outcomes and cost of care.Evaluate plan and vendor performance (financial, clinical, operational, and member experience outcomes, including ROI analysis) to support contract renewals and strategic partnerships.Support benefits strategy and leadership through analysis, reporting, and recommendations related to benefit programs and plan design.Develop and present clear, compelling materials that communicate key insights and recommendations to senior-level executives.Lead projects by aligning stakeholders, communicating progress, and ensuring timely delivery of required work products.Identify opportunities to leverage on-site health centers to improve member health outcomes and reduce external claims costs.Perform other duties and special projects as assigned by the Sr. Director, Health Plan and Benefits.
