Triple-S
About Us
At Triple S, we are committed to provide meaningful job experiences for Valuable People (Gente Valiosa). We encourage an environment of very high ethical standards, always excelling in service, collaboration among the company, agility to deliver timely, and embracing accountability for results. When you join Triple S, you will be key to our efforts on delivering high-quality and affordable healthcare as well as contribute to our purpose to enable healthier lives. We serve more than 1 million consumers in Puerto Rico through our Medicare Advantage, Medicaid, Commercial, Life and Property & Casualty Businesses. Let\'s build healthier communities together, join now! About The Role
The Medical Cost Senior Consultant is a strategic and analytical role that supports and leads initiatives that identify, analyze, and manage medical cost and revenue drivers across our health plan lines of business. This role will work cross-functionally with Clinical, Finance, Network, Pharmacy, and Analytics teams to drive initiatives that improve affordability and value. The ideal candidate combines strong data-driven decision-making skills with deep knowledge of Health Plan Operations, Clinical Operations, Provider Contracting, and Network Strategy. What You\'ll Do
Medical Cost Analysis & Opportunity Identification Analyze cost trends across service categories (e.g., inpatient, outpatient, pharmacy, post-acute, DME). Identify high-cost drivers and areas of variation across geographies, provider groups, and service types. Develop actionable insights and business cases to reduce unnecessary utilization and improve care efficiency. Work cross-functionally across the health business with business leaders to identify, develop, validate and track year over year medical cost containment and revenue development opportunities. Initiative Leadership & Execution Partner with internal stakeholders (clinical, network, pharmacy, etc.) to design and implement cost containment initiatives. Track initiative execution, monitor financial impact, and support course-correction as needed. Serve as a SME for high-priority initiatives (e.g., site-of-care optimization, provider performance programs, risk adjustment improvements, benefit redesigns). Collaboration with Provider & Clinical Teams Support differentiated contracting strategies by contributing to performance benchmarks and shared savings opportunity assessments (capitation, value-based, etc.). Collaborate with care management and UM teams to align interventions with key cost and quality levers. Work with provider performance and network teams to address provider leakage, out-of-network utilization, and cost outliers. Data Reporting & Governance Support development of dashboards and performance reports to communicate medical cost trends and initiative progress. Ensure accuracy and consistency in cost reporting across departments. Present findings and recommendations to senior leadership. What You'll Bring
Bachelor’s degree required; Master’s degree in Health Administration, Public Health, Business, or related field strongly preferred. 5+ years of experience in healthcare analytics, medical economics, health plan operations, or provider strategy. Job Details
Seniority level : Not Applicable Employment type : Contract Job function : Finance and Sales Industries : Insurance Closing Date It is company policy to seek qualified applicants for positions throughout the company without distinction of race, color, national origin, religion, sex, gender identity, real or perceived sexual orientation, civil status, social condition, political ideologies, age, physical or mental disability, veteran status or any other characteristic protected by law. Drug-free company. Equality Employment Opportunity/Affirmative Action for People with Disabilities/Veterans. Employer with E-Verify to verify the eligibility of employment of all the new employees. We encourage Veterans and Disabled to Apply. #J-18808-Ljbffr
At Triple S, we are committed to provide meaningful job experiences for Valuable People (Gente Valiosa). We encourage an environment of very high ethical standards, always excelling in service, collaboration among the company, agility to deliver timely, and embracing accountability for results. When you join Triple S, you will be key to our efforts on delivering high-quality and affordable healthcare as well as contribute to our purpose to enable healthier lives. We serve more than 1 million consumers in Puerto Rico through our Medicare Advantage, Medicaid, Commercial, Life and Property & Casualty Businesses. Let\'s build healthier communities together, join now! About The Role
The Medical Cost Senior Consultant is a strategic and analytical role that supports and leads initiatives that identify, analyze, and manage medical cost and revenue drivers across our health plan lines of business. This role will work cross-functionally with Clinical, Finance, Network, Pharmacy, and Analytics teams to drive initiatives that improve affordability and value. The ideal candidate combines strong data-driven decision-making skills with deep knowledge of Health Plan Operations, Clinical Operations, Provider Contracting, and Network Strategy. What You\'ll Do
Medical Cost Analysis & Opportunity Identification Analyze cost trends across service categories (e.g., inpatient, outpatient, pharmacy, post-acute, DME). Identify high-cost drivers and areas of variation across geographies, provider groups, and service types. Develop actionable insights and business cases to reduce unnecessary utilization and improve care efficiency. Work cross-functionally across the health business with business leaders to identify, develop, validate and track year over year medical cost containment and revenue development opportunities. Initiative Leadership & Execution Partner with internal stakeholders (clinical, network, pharmacy, etc.) to design and implement cost containment initiatives. Track initiative execution, monitor financial impact, and support course-correction as needed. Serve as a SME for high-priority initiatives (e.g., site-of-care optimization, provider performance programs, risk adjustment improvements, benefit redesigns). Collaboration with Provider & Clinical Teams Support differentiated contracting strategies by contributing to performance benchmarks and shared savings opportunity assessments (capitation, value-based, etc.). Collaborate with care management and UM teams to align interventions with key cost and quality levers. Work with provider performance and network teams to address provider leakage, out-of-network utilization, and cost outliers. Data Reporting & Governance Support development of dashboards and performance reports to communicate medical cost trends and initiative progress. Ensure accuracy and consistency in cost reporting across departments. Present findings and recommendations to senior leadership. What You'll Bring
Bachelor’s degree required; Master’s degree in Health Administration, Public Health, Business, or related field strongly preferred. 5+ years of experience in healthcare analytics, medical economics, health plan operations, or provider strategy. Job Details
Seniority level : Not Applicable Employment type : Contract Job function : Finance and Sales Industries : Insurance Closing Date It is company policy to seek qualified applicants for positions throughout the company without distinction of race, color, national origin, religion, sex, gender identity, real or perceived sexual orientation, civil status, social condition, political ideologies, age, physical or mental disability, veteran status or any other characteristic protected by law. Drug-free company. Equality Employment Opportunity/Affirmative Action for People with Disabilities/Veterans. Employer with E-Verify to verify the eligibility of employment of all the new employees. We encourage Veterans and Disabled to Apply. #J-18808-Ljbffr