Job Description
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Company Overview
A healthcare technology organization is reimagining how people access care by bringing healthcare services directly into patients’ homes. Its platform uses technology inspired by leading marketplace and last-mile delivery systems to make preventive and chronic care more accessible, particularly for patients who face barriers to visiting traditional healthcare facilities.
Key Responsibilities
Actuarial & Economic Modeling
- Build total-cost-of-care, PMPM, and MLR models using administrative claims data to quantify the long-term impact of healthcare programs.
- Project how interventions influence healthcare costs, utilization, and risk across multi-year periods.
- Quantify and communicate uncertainty associated with long-term projections.
- Produce model outputs and analytical tables that payer actuarial teams can incorporate directly into pricing, reserving, and bid processes.
- Develop rigorous financial models that demonstrate the economic value of healthcare interventions.
Payer Credibility & Commercial Support
- Represent the organization in MLR and medical-economics discussions with health plans and their actuarial teams.
- Translate analytical findings into clear value narratives that can support quality, risk, and financial decision-making.
- Support commercial teams in evaluating and communicating the financial impact of healthcare programs.
- Provide actuarially grounded analysis to help support pricing and business development activities.
Measurement & Analytical Rigor
- Establish rigorous methodologies for determining whether an intervention has genuinely influenced healthcare costs and outcomes rather than simply being correlated with them.
- Partner with data science teams on causal inference, experimental design, and measurement strategies.
- Clearly distinguish between value that can be demonstrated through evidence and value that remains an assumption or hypothesis.
- Promote analytical transparency and methodological rigor across actuarial and economic modeling activities.
Required Qualifications
- Deep experience building actuarial or health-economic models using administrative claims data.
- Strong knowledge of total cost of care, PMPM, healthcare utilization, trend, and risk modeling.
- Strong understanding of methodologies used by health payers, including MLR, risk adjustment, and multi-year financial projections.
- Strong SQL skills.
- Proficiency in Python or R.
- Ability to build, maintain, and own quantitative models from beginning to end.
- Ability to communicate effectively with actuaries and medical-economics teams.
- Strong ability to explain complex analytical findings to non-technical stakeholders.
- Sound understanding of causal inference and the ability to clearly identify what an analytical design can and cannot establish.
- Strong quantitative reasoning and analytical problem-solving skills.
Preferred Qualifications
- Actuarial credentials such as ASA, FSA, or MAAA, or demonstrated progress toward actuarial examinations.
- Experience working on the payer side, in value-based care, or within risk-bearing healthcare organizations.
- Familiarity with Medicare Advantage, Stars, and risk adjustment.
- Experience producing analytical work that customers or partners have incorporated into pricing or reserving processes.
- Experience working with healthcare financial and actuarial datasets.
- Fluency with AI coding assistants such as Claude Code or Cursor as part of a day-to-day development workflow.
- Ability to operate effectively in a first-of-function role and establish analytical standards and processes.
Disclaimer
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