Claudio Goregoitia
Wayne,NJ
Summary
Accomplished healthcare analytics leader with 19 years of experience in pharmaceutical and healthcare sectors, specializing in managed care, medical cost management, and data-driven strategy. Proven ability to drive cost-saving initiatives, lead high-performing teams, and align analytics with enterprise goals in competitive, regulated markets.
Results-driven leader with strong background in strategic management and organizational growth. Skilled in developing and implementing effective business strategies, optimizing processes, and driving team performance. Known for adaptability, effective collaboration, and delivering measurable outcomes in dynamic environments.
Overview
21
21
years of professional experience
Work History
Director – Healthcare Analytics
FIDELIS CARE
07.2019 - Current
- Lead and mentor high-performing teams within Medical Economics and Clinical Analytics; promote continuous development and cross-functional knowledge sharing.
- Collaborate with the CFO and executive leadership to lead enterprise-wide analytics initiatives aligned with strategic goals.
- Monitor key business metrics and deliver actionable reports and recommendations to senior leadership for data-driven decision-making.
- Spearheaded cost-saving initiatives that contributed over $300M toward Medicaid and Medicare budget targets.
- Developed dynamic dashboards and financial models to track performance, uncover cost drivers, and inform strategic planning.
- Strengthened cross-functional collaboration with Finance, Claims, and Provider teams to streamline operations and improve workflow efficiency.
Senior Manager – Medical Economics
FIDELIS CARE
07.2019 - 04.2023
- Foster the growth and development of a high-performing team of analysts and emerging leaders.
- Optimize medical trend reporting to surface key leading indicators and support proactive decision-making.
- Lead Cost of Care meetings to evaluate product performance and uncover cost-saving opportunities.
- Design and maintain financial models and trackers to monitor Health Benefit Ratio (HBR) savings initiatives.
- Partner with the Special Investigations Unit (SIU) to identify outliers and support Fraud, Waste, and Abuse (FWA) detection efforts.
- Deliver actionable data insights to identify disparities, guide resource allocation, and inform culturally responsive service planning.
Manager – Medical Economics
HEALTHFIRST
04.2016 - 07.2019
- Mentor and manage a team of four analysts, fostering professional growth and performance excellence.
- Present monthly product performance packages to executive leadership and engage key stakeholders in strategic discussions.
- Develop Return on Investment (ROI) analyses to assess the impact and effectiveness of clinical programs.
- Ensure timely and accurate delivery of internal and external reporting deliverables.
- Led Medical Cost team to exceed annual savings targets, achieving $120M in 2017 and $158M in 2018.
Senior Healthcare Economics Consultant
HEALTHFIRST
04.2016 - 05.2017
- Provide analytical support to Medical Management, Ancillary, and Provider Network departments to drive data-driven decision-making.
- Analyze the financial performance of all lines of business, identifying emerging trends and areas for improvement.
- Support the Pharmacy team in identifying key pharmacy cost drivers and recommending potential formulary changes.
- Assist in developing Pharmacy strategies for high-cost drug categories, including Diabetes and Hepatitis C (Hep C).
Senior Healthcare Economics Consultant
UNITEDHEALTH GROUP
06.2014 - 03.2016
- Design and manage models used for initiative planning to achieve targeted affordability savings.
- Oversee Northeast regional pharmacy initiatives and provide analytical support to the clinical team.
- Prepare and present emerging drug trend reports, highlighting market drivers for new drugs, cost implications, and utilization patterns.
- Manage pharmacy initiatives across Northeast markets (NY, NJ, PA, MD, MA, RI, DE) in collaboration with designated clinical pharmacists to drive pharmacy savings.
- Present actionable recommendations to the clinical team for reducing future claims costs.
- Provide analytical support to the health plan, focusing on trend drivers within Inpatient, Outpatient, and Pharmacy categories.
Senior Product Manager - Product Management & Oversight
EXPRESS SCRIPTS
12.2005 - 06.2014
- Lead the end-to-end execution of physician outreach drug conversion programs and support multi-channel patient outreach initiatives (letter, email, and calling).
- Manage program enhancement projects aimed at driving increased benefits, margin, volume, and conversions.
- Monitor product performance in collaboration with cross-functional teams to ensure ongoing program effectiveness.
- Lead investigations into operational, technical, or communication issues, coordinating cross-functional teams to deliver timely and cost-effective solutions.
- Perform ad-hoc data analysis using SQL programming to support decision-making and optimize program outcomes.
Senior Financial Analyst - Rebate Accounting
EXPRESS SCRIPTS
12.2005 - 02.2012
- Complete ad-hoc reporting to calculate ingredient cost and dispensing fee guarantee calculation for our monthly accruals.
- Manage over two hundred clients and provide detailed analysis to clients, account management, and pricing.
- Review all new contracts for terms, exclusions, and pricing changes.
Staff Accountant
BENJAMIN MOORE & COMPANY
03.2004 - 12.2005
- Prepared monthly, quarterly, and annual financial statements for senior management reporting.
- Executed recurring and non-recurring journal entries as part of the monthly close process.
- Generated detailed monthly Profit and Loss (P&L) statements to support financial analysis and planning.
Education
Bachelor of Science - Finance
William Paterson University
Wayne, NJ01.2003
Skills
- SQL, SAS, Tableau, Power BI, Excel (Advanced), Oracle, SAP, Hyperion, Essbase, R, Access, Teradata, Snowflake
- Healthcare Analytics Strategy, Medical Cost Management, Health Equity, Value-Based Care, ROI Modeling, Fraud, Waste & Abuse (FWA), Payment Integrity, Project Management
- Strategic planning
- Decision-making
Tools & Technologies:
Core Competencies:
- Team management
- Employee development
- Financial reporting
- Business development
- Project management
Timeline
Director – Healthcare Analytics
FIDELIS CARE
07.2019 - Current
Senior Manager – Medical Economics
FIDELIS CARE
07.2019 - 04.2023
Manager – Medical Economics
HEALTHFIRST
04.2016 - 07.2019
Senior Healthcare Economics Consultant
HEALTHFIRST
04.2016 - 05.2017
Senior Healthcare Economics Consultant
UNITEDHEALTH GROUP
06.2014 - 03.2016
Senior Product Manager - Product Management & Oversight
EXPRESS SCRIPTS
12.2005 - 06.2014
Senior Financial Analyst - Rebate Accounting
EXPRESS SCRIPTS
12.2005 - 02.2012
Staff Accountant
BENJAMIN MOORE & COMPANY
03.2004 - 12.2005
Bachelor of Science - Finance
William Paterson University
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