Director, Medical Cost Economics
RemoteCommercial Employer HealthMedicaidMedicare AdvantageProduct Development & Plan DesignPredictive Modelling & MLBusiness Intelligence & Reporting
Role Summary
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Director-level health actuarial role at UPMC Health Plan focused on medical cost economics. You will develop actuarial and financial models, identify medical cost drivers, and drive cross-functional cost improvement strategies. The role manages analysts, requires ASA/FSA and AAA membership, and is remote within the continental US with occasional travel to Pittsburgh.
JOB DESCRIPTION SUMMARY
- Lead development of actuarial and financial models to evaluate medical cost initiatives
- Drive medical cost improvement strategies across clinical, network, and finance teams
- Manage one or more analysts and partner with senior Health Plan leadership
- Remote role (continental US) with travel to Pittsburgh 2–3 times per year
- Requires ASA or FSA and membership in the American Academy of Actuaries
DOMAIN EXPERTISE
- Value-based reimbursement
- Population health
- Segmentation/stratification
- Claims development
- Commercial and government health programs
KEY REQUIREMENTS
- ASA or FSA certification required and American Academy of Actuaries membership
- 8+ years of progressive actuarial work in health insurance, managed care, or consulting
- Bachelor’s degree in math/stats/actuarial science/economics required
- Data retrieval skills and relational database experience required
- Experience with commercial and government health programs preferred
TECH STACK
- No tech stack specified
