• Develop and maintain risk‑stratification frameworks to identify high‑risk and emerging‑risk members for care management, utilization management, and disease management programs • Build and refine predictive models for hospitalization, readmissions, ED utilization, progression of chronic disease, and care gap closure • Translate model outputs into actionable insights for clinical operations, network management, and product teams • Evaluate medical cost trends with clear decomposition of unit cost, utilization, service mix, and demographic drivers • Quantify financial risk across populations, benefit designs, provider arrangements, and value‑based care programs • Conduct deep‑dive analyses into cost containment opportunities, high‑cost cohorts, and avoidable utilization • Partner with Utilization Management and Clinical Operations to reconcile authorization, admission, and bed‑day data with paid claims; ensure accuracy and consistency of operational metrics • Lead or participate in cross‑functional governance of measure definitions to align IT, Finance, Clinical, and Operational areas • Develop predictive KPIs and operational forecasts to support proactive business management • Prototype data pipelines, dashboards, and analytical tools to support evolving business needs • Work hands‑on with medical and pharmacy claims data to validate assumptions, troubleshoot anomalies, and uncover business insights • Promote best practices in data quality, metadata management, and analytic reproducibility • Lead cross‑functional analytic initiatives, ensuring alignment with organizational strategy and CMS program requirements • Provide coaching, mentorship, and technical training to analytics staff • Address performance gaps, support professional development, and uphold team accountability standards • Perform other duties as required to support the broader health plan economics and analytics agenda