Manager, Value-Based Care Actuarial Analytics
Manager, Value-Based Care Actuarial Analytics
A major health plan is seeking a credentiale actuary to lead financial analysis and strategy related to provider reimbursement and value-based care initiatives. This individual will be responsible for evaluating provider performance, developing financial forecasts, identifying cost-saving opportunities, and partnering with senior leadership to drive healthcare affordability and operational effectiveness.
This is a highly visible, fully remote leadership opportunity that combines actuarial analytics, healthcare economics, provider contracting, and strategic business decision-making.
Key Responsibilities
Value-Based Care Strategy & Analytics
- Lead financial analysis supporting value-based provider arrangements and alternative payment models.
- Evaluate the performance of provider contracts and identify opportunities to improve cost, quality, and overall value.
- Develop actionable insights related to healthcare utilization, medical cost trends, and provider performance.
- Support the design and measurement of value-based reimbursement initiatives across multiple lines of business.
Financial Forecasting & Performance Monitoring
- Build and oversee financial models used to project provider contract performance and healthcare spending.
- Analyze key drivers of medical cost trends and provide recommendations to improve financial outcomes.
- Monitor performance against expectations, identify emerging risks, and communicate findings to leadership.
- Support long-term strategic planning through actuarial and economic analysis.
Leadership & Cross-Functional Collaboration
- Manage and mentor a small team of actuarial and analytical professionals.
- Partner closely with leadership teams across actuarial, network management, finance, clinical, and strategy functions.
- Translate complex analytical findings into actionable recommendations for executive stakeholders.
- Foster a collaborative, high-performing team culture focused on innovation and continuous improvement.
Process Improvement & Innovation
- Enhance analytical methodologies, forecasting capabilities, and reporting processes.
- Leverage large healthcare datasets to uncover trends and support strategic initiatives.
- Drive operational improvements that increase efficiency, scalability, and decision-making effectiveness.
Qualifications
- Bachelor's degree in Actuarial Science, Mathematics, Statistics, Economics, Finance, or a related field.
- ASA designation required; FSA preferred.
- 7+ years of health actuarial experience.
- Previous experience analyzing provider reimbursement arrangements, value-based care programs, or medical cost performance strongly preferred.
- Prior people management or team mentorship experience required.
- Strong understanding of healthcare economics, medical cost drivers, and health insurance financial performance.
- Experience building and presenting complex financial analyses to senior leadership.
- Excellent communication, project management, and stakeholder management skills.
Preferred Experience
- Value-based care analytics.
- Provider contract financial modeling.
- Total cost of care analysis.
- Claims-based experience studies.
- Healthcare trend analysis and forecasting.
- Commercial and/or government-sponsored health programs.
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