Note: The job is a remote job and is open to candidates in USA. A major health plan is seeking a credentialed actuary to lead financial analysis and strategy for provider reimbursement and value-based care initiatives. The Manager will evaluate provider performance, develop financial forecasts, identify cost-saving opportunities, manage a small analytical team, and partner with senior leadership to improve healthcare affordability and operational effectiveness.
Responsibilities
- 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
- 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
- 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
- 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
Skills
- • Bachelor's degree in Actuarial Science, Mathematics, Statistics, Economics, Finance, or a related field
- • ASA designation required
- • 7+ years of health actuarial experience
- • 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
- FSA preferred
- • Previous experience analyzing provider reimbursement arrangements, value-based care programs, or medical cost performance strongly preferred
- • 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
Benefits
- Fully remote leadership opportunity
Company Overview