Job Description
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Company Overview
A healthcare technology company is focused on improving access to care by bringing healthcare services directly into patients’ homes. Its technology-enabled care model is designed to help patients receive preventive and chronic care while reducing barriers associated with traditional healthcare delivery.
Key Responsibilities
Actuarial & Economic Modeling
- Build total-cost-of-care, PMPM, and MLR models using administrative claims data.
- Quantify the long-term financial impact of healthcare programs and interventions.
- Project changes in healthcare costs, utilization, and risk over multi-year horizons.
- Quantify and communicate uncertainty associated with economic projections.
- Produce model outputs and tables that payer actuarial teams can incorporate into pricing, reserving, and bid work.
- Develop defensible methodologies for evaluating the economic value of healthcare interventions.
Payer Credibility & Commercial Support
- Represent the organization in MLR and medical-economics discussions with health plans.
- Engage directly with payer actuaries and medical-economics teams to explain methodologies and findings.
- Translate quantitative analysis into value narratives that quality, risk, and finance teams can use.
- Support commercial teams in pricing and communicating the economic impact of healthcare programs.
- Develop analyses that can support customer and partner decision-making.
Measurement & Analytical Rigor
- Define appropriate methodologies for determining whether interventions caused measurable changes in healthcare costs and outcomes.
- Partner with Data Science teams on causal inference, experimental design, and measurement strategies.
- Clearly distinguish between value that can be demonstrated through available evidence and value that remains an assumption or projection.
- Apply rigorous analytical methods to ensure models and conclusions are defensible.
- Continuously improve modeling approaches based on new data, evidence, and business requirements.
Required Qualifications
- Deep experience building actuarial or health-economic models using administrative claims data.
- Experience with total cost of care, PMPM, healthcare utilization, trend analysis, and risk modeling.
- Strong understanding of methodologies used by health payers, including MLR, risk adjustment, and multi-year projections.
- Strong judgment regarding the appropriate application and limitations of actuarial and health-economic methodologies.
- Strong SQL skills.
- Proficiency in Python or R.
- Ability to independently build, maintain, and own analytical models end to end.
- Ability to communicate effectively with actuaries, medical-economics teams, and other non-technical stakeholders.
- Strong understanding of causal inference and the ability to communicate what an analytical design can and cannot demonstrate.
- Ability to translate complex quantitative analysis into clear business and economic insights.
Preferred Qualifications
- Actuarial credentials such as ASA, FSA, or MAAA, or demonstrated progress toward actuarial examinations.
- Experience working with health payers, value-based care organizations, or risk-bearing entities.
- Familiarity with Medicare Advantage, Stars, and risk adjustment.
- Experience producing analyses that customers or partners have incorporated into pricing or reserving processes.
- Experience using AI coding assistants such as Claude Code or Cursor as part of a development workflow.
Work Environment
The organization operates on a hybrid schedule, with employees working from the office Monday through Thursday and working from anywhere on Fridays. The workplace emphasizes collaboration while maintaining flexibility and work-life balance.
Employees have access to provided lunch each day, with the team sharing an hour together as an opportunity to connect outside of regular meetings.
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