A major health plan is seeking a credentialed 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.
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.
