About this role
Accountabilities
- Model provider performance across CMS and CMMI programs, including MSSP, ACO REACH, and LEAD, covering benchmarks, projections, attribution, risk scores, savings and losses, and scenario analysis.
- Evaluate value-based contracts from the provider perspective, including shared savings and downside risk, global and primary care capitation, bundled payments, episode-based arrangements, and downstream distribution of risk and rewards.
- Model provider reimbursement arrangements and support payer contract and rate negotiations with quantitative analysis.
- Analyze detailed claims, enrollment, CMS, and healthcare data to identify utilization patterns, cost drivers, risk-adjustment dynamics, and network performance opportunities.
- Lead consulting projects by defining scope, managing budgets and timelines, delegating technical work, coordinating deliverables, and communicating directly with clients.
- Develop clear client-facing deliverables, including emails, memoranda, presentations, reports, and other materials designed for financial and clinical leadership.
- Support proposal development and contribute to additional healthcare consulting engagements as business needs evolve.
- Apply sound actuarial judgment to determine the most relevant analysis for each client question and translate technical findings into practical business recommendations.
- Build and maintain strong client relationships while progressively developing capabilities in client management and business development.
- Collaborate with actuarial professionals, healthcare consultants, analysts, and other specialists in a multidisciplinary consulting environment.
Requirements
- Bachelor’s degree in actuarial science, mathematics, statistics, economics, or another quantitative discipline.
- Fellowship in the Society of Actuaries (FSA) or equivalent professional actuarial designation.
- 5–8 years of healthcare actuarial experience, including a strong understanding of provider perspectives and financial considerations.
- Hands-on experience with at least one CMS or CMMI total cost-of-care program, such as MSSP, ACO REACH, Primary Care First, or a bundled payment model.
- Experience developing benchmarks for CMS/CMMI programs or other risk-based healthcare arrangements, as well as familiarity with attribution methodologies.
- Knowledge of provider reimbursement models, including fee schedules, capitation, case rates, episode payments, and related contractual structures.
- Advanced Excel skills and experience working with detailed healthcare claims data.
- Experience with SQL, Python, R, SAS, or comparable analytical tools.
- Demonstrated project management experience, including scoping, budgeting, delegation, timeline management, and client communication.
- Ability to explain complex actuarial and analytical concepts clearly to non-technical audiences.
- Strong understanding of the U.S. healthcare system and the financial dynamics of value-based care.
- Proactive, self-directed approach with the judgment to move projects forward independently while incorporating appropriate senior-level review.
- Strong written and verbal communication skills, with the ability to produce polished client-facing materials.
- Ability to work effectively both independently and collaboratively in a fast-paced, client-focused environment.
- Preferred experience with CMS Claim and Claim Line Feed (CCLF) data, CMS/CMMI participation modeling, payer contract negotiations, proposals, or client reports.
- Must be legally authorized to work in the United States without current or future immigration sponsorship.
Benefits
- Remote work environment, with the option to work onsite from select office locations.
- Base salary ranging from $103,500 to $214,820 , depending on location, experience, qualifications, skills, and certifications.
- For candidates in Alaska, California, Connecticut, Illinois, Maryland, Massachusetts, New Jersey, New York City, Pennsylvania, Virginia, Washington, and Washington, D.C., the salary range is $119,025–$214,820 .
- For other U.S. locations, the salary range is $103,500–$186,800 .
- Eligibility for a discretionary bonus program; paid bonuses routinely exceed 25% of base salary, although actual amounts vary based on workload and billable hours.
- Medical, dental, and vision coverage for employees, dependents, and domestic partners.
- 401(k) plan with company matching and profit-sharing contributions.
- Employee Assistance Program providing confidential personal and work-related support.
- Flexible Spending Accounts for eligible medical, dependent-care, transportation, and other qualifying expenses.
- Paid time off beginning on the first day of employment, with full-time employees accruing 15 days annually.
- At least 10 paid holidays per year.
- Family-building benefits, including adoption and fertility assistance.
- Up to 11 weeks of paid parental leave for eligible employees.
- Company-paid life insurance and AD&D coverage.
- Fully company-paid short-term and long-term disability coverage.
- Access to professional development, skills training, mentoring, healthcare data resources, and modeling tools.
How Jobgether works:
We use an AI-powered matching process to ensure your application is reviewed quickly, objectively, and fairly against the role's core requirements. Our system identifies the top-fitting candidates, and this shortlist is then shared directly with the hiring company. The final decision and next steps (interviews, assessments) are managed by their internal team.
We appreciate your interest and wish you the best!
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