Responsibilities
- Own savings forecasts and monthly financial close for all value-based contracts, including shared savings accruals, reserves, and IBNR development
- Build and maintain financial models capturing performance drivers under MLR-based and RCT-based contract structures; monitor cost trends and provide early warnings of variances with recommended actions
- Serve as the technical authority on total cost of care projections, conducting and reviewing sophisticated analyses, cost trend studies, and actuarial modeling as needed
- Lead year-end contract reconciliation with health plan actuaries and provide actuarial/financial guidance during contract negotiations
- Develop underwriting frameworks (MLR targets, performance guarantees, risk corridors) and build methodologies to accurately measure organizational performance across contract structures
- Perform deep-dive cost trend analyses to identify clinical impact opportunities; generate insights that drive clinical model innovation and support strategic planning across market opportunities and growth scenarios
- Serve as the primary technical counterpart to health plan actuaries during data validation, reconciliation, and negotiations
- Lead discussions to resolve methodology differences and communicate findings clearly to non-technical stakeholders
- Develop compelling value narratives and analytical exhibits that translate complex medical economics findings into actionable recommendations
- Build, grow, and lead a best-in-class medical economics and actuarial function
- Develop analytical tools, data infrastructure, and reporting frameworks that improve team efficiency and scale capabilities
- Dive deep into data quality issues and work cross-functionally to resolve discrepancies; write analytical memos and reports that communicate findings to senior leadership
Requirements
- Advanced degree in a quantitative field (actuarial science, statistics, mathematics, economics, public health, or related)
- 10+ years of progressive experience in health actuarial science or medical economics, with at least 3-5 years in a leadership role
- Demonstrable expertise in Medicaid, including capitation, risk adjustment, MLR requirements, and regulatory frameworks
- Proven track record with value-based care arrangements, shared savings contracts, and risk-bearing models, including contract underwriting, performance forecasting, and financial reconciliation
- Expert-level proficiency in actuarial and medical economics methodologies (reserving, pricing, trend analysis, total cost of care modeling); strong SQL, Python, and/or R skills; advanced Excel/financial modeling; and experience with large, complex healthcare datasets
- Demonstrated ability to build and lead high-performing analytical teams in growth-stage organizations, with exceptional communication skills across technical and non-technical audiences
- Equal parts strategic thinker and hands-on executor — able to build vision and infrastructure while personally conducting sophisticated analyses
- Comfortable with ambiguity, fast-moving priorities, and building effective cross-functional partnerships
Nice to Have
- ASA credential or meaningful progress toward FSA
- Deep Medicaid managed care experience, including state program variations, CMS regulations, and actuarial standards of practice (ASOP)
- Understanding of care delivery models, clinical quality measures, and the relationship between clinical interventions and medical costs
- Experience building analytical functions from the ground up in early-stage or high-growth companies
- Genuine commitment to improving care for underserved populations and closing health equity gaps
Benefits
- Stock Options
- Work-from-Home Stipend
- Medical, Vision, and Dental Coverage
- Life Insurance
- Paid Time Off
- Parental Leave
- Retirement Savings
- Commuter Benefits
- Professional Development Stipend
Additional Information
- Offer of employment is contingent upon successful completion of a background check.
