Healthcare Economics Consultant, Risk Adjustment - Remote
About the position Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together. You’ll enjoy the flexibility to work remotely from anywhere within the U.S. as you take on some tough challenges. Positions in this function research and investigate key business problems through quantitative analyses of utilization and healthcare costs data. Provides management with statistical findings and conclusions. Identifies potential areas for medical cost improvements and alternative pricing strategies. Provides data in support of actuarial, financial and utilization analyses Generally work is self-directed and not prescribed Works with less structured, more complex issues Serves as a resource to others You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.
Responsibilities
- Support monthly and quarterly revenue forecasting processes under direction of senior analysts and managers
- Assist in validating data inputs, reconciling outputs, and documenting key assumptions and changes
- Work with large healthcare datasets using SQL and Excel to manipulate, extract, and analyze data
- Collaborate with data engineering and finance teams to ensure accurate and timely data availability
- Help build and refine standardized forecast models and dashboards
- Interpret CMS Risk Adjustment model logic and incorporate changes into existing templates
- Participate in data validation, forecast review sessions, and documentation efforts
- Present findings and insights in a clear and concise manner to internal stakeholders
- Learn risk adjustment methodologies, forecasting techniques, and CMS specifications through project work and team mentorship
Requirements
- Undergraduate degree or equivalent experience.
- 1+ years of experience working with healthcare or financial data in a business or academic setting
- Experience with Medicare Advantage data files such as MMR, MOR, and MAO-004 reports through academic or professional experience
- Intermediate proficiency in SQL
- Proven solid Microsoft Excel skills (e.g., PivotTables, SUMIFS, VLOOKUPs)
- Ability to manage multiple tasks and meet deadlines with attention to detail
Nice-to-haves
- Demonstrated familiarity with Medicare Advantage or healthcare revenue forecasting
- Hands-on experience working with CMS files such as Monthly Membership Report (MMR), Medicare Advantage Outbound Reconciliation (MOR), or MAO-004 submission/return files
- Experience working in Snowflake or similar modern data platforms
- Exposure to data visualization tools and reporting (e.g., Tableau, Power BI)
- Proven solid written and verbal communication skills
- Demonstrated willingness to learn and grow into more advanced forecasting and modeling roles
Benefits
- In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements).
- No matter where or when you begin a career with us, you’ll find a far-reaching choice of benefits and incentives.
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