Data Analytics / Actuarial
Job Summary
The Managed Care Value-Based Expert provides advanced analytical support and subject-matter expertise for managed care contracting and value-based payment arrangements. The role leads complex financial modeling, contract performance evaluation, and forecasting to support negotiation strategy and enterprise decision-making. Responsibilities include preparing reimbursement analyses, evaluating value-based payment models, and monitoring contract performance.
Responsibilities
- Prepare reimbursement and financial impact analyses
- Design and evaluate value-based payment models
- Monitor contract and program performance
- Lead monthly forecasting and variance analysis
Required Skills
- Advanced proficiency in SQL and Excel
- Experience with Tableau and/or Power BI
- 3-7+ years healthcare finance or payer analytics experience
- Strong data translation and strategic insights skills
Job Details
Essential Job Functions:
- Prepare advanced reimbursement, financial impact, and performance analyses to support managed care contract negotiations and payer strategy.
- Design and evaluate value-based payment models, including shared savings, quality metrics, risk corridors, and attribution methodologies.
- Develop pro forma, sensitivity, and stress-test analyses to assess financial implications of proposed contract changes and market trends.
- Monitor contract and value-based program performance; identify underpayments, compliance gaps, payment trends, and financial risks.
- Lead monthly forecasting and prepare financial reporting packages summarizing value-based performance and variance analysis.
- Conduct quarterly and annual reconciliation audits to ensure payer compliance with contractual terms.
- Develop tools and methodologies to monitor healthcare trends and improve value-based forecasting accuracy.
- Synthesize payer data, market intelligence, and industry developments to inform negotiation strategy and executive decision-making.
- Create executive-level reporting and scalable analytic processes across programs.
- Provide technical guidance and mentorship to Managed Care Analysts and contribute to process improvements.
Required Education:
- Bachelor’s degree in Economics, Actuarial Science, Health Economics, Business Administration, Finance, Accounting, Healthcare Administration, or related field.
Work Experience Required:
- 3–7+ years of progressive experience in healthcare finance, payer analytics, medical economics, or healthcare consulting.
- Experience supporting value-based contract development including performance measurement, quality metrics, reconciliation, and dispute resolution.
- Experience in forecasting, audit, predictive analytics, and contract performance management.
- Advanced proficiency in SQL and Excel; experience with Tableau and/or Power BI.
- Experience analyzing large healthcare claims, reimbursement, and value-based datasets.
- Strong ability to translate complex data into strategic insights for diverse stakeholders.