Senior Health Care Economics & Value-Based Analyst

As the Senior Health Care Economics & Value-Based Analyst, you'll have deep expertise in actuarial methods, value-based payment modeling, predictive analytics, and medical cost economics. This role will support the design, evaluation, and optimization of value-based pricing and performance frameworks across Commercial, Medicare (including Medicare Advantage), and Medicaid populations. The ideal candidate combines actuarial discipline (MAA/ASA track preferred), advanced statistical modeling expertise, and strong hands-on data capability (SQL, Tableau, Excel), with experience operating in complex payer and provider environments.

Success Measures:

• In 3 months:
• Gain full command of data, methodologies, and value-based program mechanics.
• Deliver early validated insights that build stakeholder confidence.

In 6 months:

• Translate analytics into actionable financial and clinical insights.
• Own development of methodologies for program evaluation, performance normalization, and predictive insights for value-based programs.

In 12 months:

• Architect scalable value-based pricing and performance frameworks.
• Inform network, contracting, clinical, and financial decisions with advanced analytics.
• Demonstrate measurable enterprise impact on cost, quality, and risk performance.

Responsibilities:

• Develop actuarially sound pricing models for Episodes of Care/Bundled Payments, Total Cost of Care (TCOC) programs, Shared Savings/Shared Risk arrangements, and sub-capitation and specialty value-based programs
• Construct prospective and retrospective target-setting methodologies using difference-in-differences approaches, market benchmarking, credibility weighting, and risk-adjusted baselines
• Evaluate financial and quality performance across Commercial, Medicare Advantage, and Medicaid lines of business
• Support pricing validation, reconciliation modeling, and performance evaluation analyses
• Develop and operationalize predictive models for cost, utilization, quality outcomes, and performance evaluation using random forest, gradient boosting (preferred), propensity score matching, logistic regression/GLMs, and/or multivariate and hierarchical modeling
• Build provider performance classifiers and volume-based credibility frameworks
• Conduct contracted vs. non-contracted provider performance comparisons
• Support steerage, network optimization, and care management analytics
• Perform medical cost trend decomposition (unit cost vs. utilization vs. intensity vs. mix)
• Conduct risk-adjusted PMPM analysis across specialties, site-of-service, and population segments
• Analyze longitudinal performance across defined assessment periods
• Quantify impact of specialty utilization patterns and referral dynamics
• Evaluating acuity, case-mix, and coding impacts across populations
• Write advanced SQL queries to construct episode-level, provider-level, and member-month
• datasets
• Develop repeatable analytic workflows supporting production modeling
• Build executive-facing dashboards in Tableau
• Construct Excel-based financial models for pricing and reconciliation analyses

Position Requirements:

• Bachelors degree in a STEM field (Statistics, Mathematics, Economics, Engineering, Computer Science, or related), with Master's degree preferred (Health Economics, Data Science, Biostatistics, Applied Statistics, or related quantitative discipline), or equivalent work experience
• 5+ years of experience working within a payer or provider organization, or with healthcare analytics or care management organizations
• Demonstrated experience across Commercial, Medicare (including MA), and Medicaid populations
• Deep experience working the following types of data:
• Medical claims data
• Enrollment and eligibility data
• Provider data
• CMS revenue and risk adjustment data
• Value-based performance datasets
• Familiarity with EMR/EHR and SDOH
• Strong proficiency in SQL, Tableau, and Excel
• Experience utilizing Python or R is a plus

Position Perks:

Enlace Health offers competitive benefits and perks to all our employees! Our comprehensive benefits package is one of the many ways we show our employees how valued they are. All full-time employees are eligible for the following:

• FREE medical, dental, and vision insurance for employees on select plans
• $1740 annual contribution into qualifying HSAs
• UNLIMITED time off
• Matching 401(k) plan
• Mac laptop and accessories
• Company-paid short-term and long-term disability
• Company-paid life insurance
• Employee Assistance Program
• Annual professional development stipend

All employees are required to maintain confidentiality as related to patient information. Employees are required to follow the acceptable use policy while using any information systems owned or controlled by Enlace. Any disclosures of confidential information made unlawfully outside the proper course of duty will be treated as a serious disciplinary offense. Security roles and responsibilities include:

• Implementing and acting in accordance with the organization's information security policies
• Protecting assets from unauthorized access, disclosure, modification, destruction, or interference
• Executing particular security processes or activities
• Ensuring responsibility is assigned to the individual for actions taken
• Reporting security events or potential events or other security risks to the organization

The above statements are intended to describe the general nature and level of work being performed by people assigned to this position. The requirements listed above are representative of the minimum knowledge, skill, and/or ability required. To perform this job successfully, an individual must be able to satisfactorily perform the essential functions of the job according to specific company requirements.