Position SummaryThis role will lead our Managed Care Contracting & Medical Economics business unit. This department is responsible for conducting quantitative analysis to determine organizational risks of participating in various value-based care programs. In addition, this person will be responsible for engaging with payor partners on negotiating both FFS and value-based arrangements for our provider network affiliates.
Responsibilities:- Apply quantitative analysis to underwrite risk across various value-based care contracts, including but not limited to P4Q, professional fee capitation, two-sided shared savings models, and global capitation arrangements.
- A strong understanding of healthcare terminology and principles, including medical coding, claims data, and broader medical economic trends, including Part A, B, and D segments.
- Strong proficiency in being able to use databases and tools to query, interpret, and build sensitivity models to evaluate risk propensity.
- Ability to take claims data and develop IBNR models to inform a prediction of future paid claims experience.
- Partner cross-functionally with internal stakeholders on legal implications of managed care negotiations, financial forecasting and budgeting, and operational delivery tactics.
- Effective verbal, written, and presentation skills to wide audiences, including physicians, executive management, and external stakeholders.
- Responsible for participating in payor JOC meetings to facilitate alignment on performance targets and goals.
Qualifications:- Bachelor's degree (B.A.) in actuarial science, healthcare economics, quantitative analysis, mathematics, or a closely related field; a statistics background would prove helpful in this role
- Experienced healthcare economist or actuary with a payor or benefits consultant background.
- ASA or FSA designation required, or progress towards such designations.
- Experience in client-facing roles
- Strong analytical abilities and proficiency with Microsoft Office, especially Word, Excel, and PowerPoint.
- Experience across different health insurance products is highly preferred, including: Medicare, Medicaid, commercial, and exchange lines of business.
Location: Miramar, FL (Hybrid or Remote)
Compensation & Benefits- $150 - 200K base salary compensation. Actual compensation offered to the successful candidate may vary from the posted hiring range based on work experience, skill level, and other factors.
- Health, dental, and vision insurance.
- 401(k)
- Paid time off and company holidays.
- Opportunity to shape the future of healthcare technology within a rapidly growing value-based care organization.
