Closer to a data-science crossover than a pure modelling IC because claims pipelines, data architecture, and automation are as central as methodology.
Senior Health actuarial analytics role in the United States, with remote work indicated. You will design and defend savings and performance-guarantee models for payer and PBM clients, using claims data, applied statistics, Python, SQL, and Databricks. The role combines healthcare economics, pricing risk, data engineering, and executive-facing communication.
Requirements
Must have
5+ years in healthcare economics, value-based contracting, payer/PBM analytics with ownership of savings/ROI/performance-guarantee methodology
Deep command of pharmacy and medical claims data, GPI-level drug logic, plan design, and savings guarantee measurement/pricing
Strong applied statistics — confidence intervals, variance and risk, cohort analysis — and actuarial-style risk thinking
Proven model craftsmanship: reusable, parameterized, well-documented models; ability to reverse-engineer inherited logic
Advanced data modeling skills — data structuring, storage, and access for reliable scalable analytics
Strong Python for data-transformation, pipeline logic, and automation
SQL fluency for complex queries, aggregations, CTEs, and transformations against large datasets
Hands-on Databricks (notebooks, workflows, Unity Catalog) and BI dashboard tools (Tableau, Power BI, or Databricks Dashboards)
Ability to use AI tools (e.g., Claude Code) to accelerate and scale analytic work
Excellent communication — explain complex methodology to executives and defend under scrutiny
Bachelor's degree in quantitative, economics, health-policy, or related field (or equivalent experience)
Strongly preferred
Graduate training in health economics, biostatistics, or related discipline; actuarial exam progress (full credentialing not required)
Direct experience pricing or evaluating performance guarantees in PBM, payer, or value-based-care setting
Lakehouse architecture experience — Delta Lake, medallion design patterns
Git-based version control workflows and code review; exposure to CI/CD pipelines applied to data engineering
Skills & Domain
ToolsExcelPower_BITableauDatabricks
DomainPayer/PBM analytics and savings guarantee methodologyPharmacy and medical claims data with GPI-level drug logicValue-based contracting and performance guarantee pricing
