Medical Economics Senior Principal

Job description

Job Description Summary: The Medical Expense and Economics Management leads the analytical and financial oversight functions within the Medicare Performance Hub, driving cost trend intelligence, utilization management insight, and medical expense forecasting for the FEP Medicare Advantage program. This role serves as a shared medical economics resource across BCBSA's Federal Employee Program and other lines of business — providing cost and utilization expertise wherever it is needed across the enterprise. This position is the primary subject matter expert on medical cost drivers and clinical economics, translating complex data into actionable strategy for plan sponsors, operations, and executive leadership. Responsibilities include but are not limited to Medicare Medical Economics & Cost Analytics • Own the development and maintenance of medical expense models, PMPM trend analyses, and cost benchmarking across supported lines of business. • Monitor and interpret utilization patterns, unit cost trends, and benefit category performance; identify variance drivers and emerging risks across programs. • Produce actuarial-quality medical cost projections in partnership with Milliman and internal finance and actuarial teams to support annual rate development, FEP rate filing, and ongoing financial monitoring. • Leads trend mitigation strategy coordination, savings sizing/tracking, and follow-up on identified issues/opportunities • Oversees/conducts monthly and weekly Cost of Care meetings to identify cost/utilization reduction opportunities; reviews and disseminates summary reports Medicare Performance Hub Integration • Serve as the medical economics lead within the Medicare Performance Hub, connecting Stars, HEDIS, quality, and care management performance data to financial outcomes. • Partner with Blue Health Intelligence and other analytics vendors to surface cost and quality insights at the plan, market and provider level. • Develop medical cost dashboards and reporting frameworks for use by BCBSA leadership and participating Blue Plans. Cross-LOB Support • Extend medical economics expertise beyond MA to support the broader Federal Employee Program and other BCBSA lines of business, including cost trend analysis, benefit design modeling, and financial benchmarking. • Serve as a connective resource between MA program infrastructure and FEP's existing medical management and analytics functions, ensuring methodological consistency and data comparability across programs. • Identify opportunities to leverage MA analytics capabilities — including the Medicare Performance Hub and vendor partnerships — to drive value across the wider FEP portfolio. Program & Strategic Support • Support the MA actuarial and financial modeling workstreams, including OPM premium savings demonstrations and capitation model analysis. • Advise on Part D cost trends, IRA restructuring implications, and risk adjustment (V28) impacts on medical expense projections. • Contribute to CMS bid strategy, supplemental benefit cost modeling, and EGWP financial design decisions. Stakeholder & Plan Engagement • Collaborate with FEPOC/CareFirst, Accenture, and participating Blue Plans on medical cost data sharing, reporting standards, and performance accountability across programs. • Present medical cost findings and trend insights to the FEP BOM, PAG, and OPM as needed. • Translate complex economics into clear narratives for non-technical audiences across multiple program stakeholders. • Trend Management Accountability & Partnership: partners with Plan team, Plan actuaries, and Plan medical officers to drive Plan and market specific trend management and total-cost-of-care reduction strategies • Proactive Opportunity Identification: leads proactive identification, sizing, and root-cause analysis of medical cost/utilization anomalies and affordability opportunities within Plans and markets The posting range for this position is: 169,800.00 - 246,225.00 Required Education, Certifications and Experience: Education Required BS Actuarial Science, Health Economics, Statistics; or equivalent experience Experience Required 12+ Years progressive experience in medical economics, healthcare actuarial analysis, or managed care financial analytics. Knowledge Skills and Abilities - Demonstrates AI literacy and an understanding of generative AI tools, including appropriate business applications and limitations. - Deep expertise in Medicare Advantage cost structures, including Part A/B/D trends, risk adjustment, EGWP plan design, and capitation modeling; familiarity with commercial or federal employee health benefits program economics a strong plus. - Proficiency with medical cost modeling tools and large claims datasets; experience with SQL, SAS, R, or Python preferred. - Strong understanding of CMS regulatory frameworks (MA bids, Star ratings, risk adjustment, IRA/Part D restructuring) and FEHB/PSHB program dynamics. - Exceptional communication skills; ability to present financial analysis clearly to executive and regulatory audiences. Certifications & Licenses Preferred: Fellow of the Society of Actuaries (FSA) - SOA Preferred: Associate of the Society of Actuaries (ASA) - SOA #LI_HYBRID The posted salary range is the lowest to highest salary we , in good faith , believe we would pay for this role at the time of this posting . We may ultimately pay more or less than the hiring range and t his hiring range may also be modified in the future. A candidate’s position within the hiring range may be based on several factors including, but not limited to, specific competencies, relevant education, qualifications, certifications, relevant experience, skills, seniority, performance, shift, travel requirements, and business or organizational needs. This job is also eligible for annual bonus incentive pay. We offer a comprehensive package of benefits including paid time off, 11 holidays, medical/dental/vision insurance, generous 401(k) matching , lifestyle spending account and m any other benefits to eligible employees. Note: No amount of pay is considered to be wages or compensation until such amount is earned, vested, and determinable. The amount and availability of any bonus, commission, or any other form of compensation that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company’s sole discretion, consistent with the law.