Director, MedEcon
FlexibleMedicaidMedicare AdvantageReserving & ValuationPricing & RatingUW Support & Portfolio Management
Role Summary
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Director-level health actuarial and medical economics role focused on Medicaid value-based contracts across the US. You’ll own savings forecasts, IBNR and reserves, build underwriting frameworks, and lead medical economics and actuarial analytics. Reports to the Chief Revenue Officer (acting CFO) and combines hands-on modelling with building a scaled analytics function.
JOB DESCRIPTION SUMMARY
- Lead financial forecasting, IBNR and reserves for Medicaid value-based contracts
- Develop underwriting frameworks and monitor MLR- and RCT-based contract performance
- Build tools, data infrastructure, and analytical exhibits to support partners
- Work closely with health plan actuaries and present to senior stakeholders
- Director role with team-building and leadership responsibilities
DOMAIN EXPERTISE
- Medicaid managed care capitation and risk adjustment
- Value-based care and shared savings contract financial forecasting
- IBNR and reserve development for healthcare claims
- Contract underwriting and MLR-based performance frameworks
- Analysis of large, complex healthcare claims datasets
KEY REQUIREMENTS
- 10+ years in health actuarial science or medical economics
- 3–5 years in a leadership role
- Deep Medicaid managed care expertise (capitation, risk adjustment, MLR)
- Expert-level reserving, forecasting, and total cost-of-care modelling
- Strong SQL and Python and/or R skills plus advanced Excel
TECH STACK
- Excel
- PowerPoint
- Jupyter_Notebook
