Health Economist
Medicare AdvantageCommercial Employer HealthHealth OtherPricing & RatingReserving & ValuationRisk Management, ERM & ORSA
Role Summary
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Senior health actuarial role focused on value-based care and MSK digital health at Hinge Health in San Francisco. You will own claims-based ROI and reserve modelling, negotiate performance guarantees with large payers, and design risk-transfer and shared-savings arrangements. The role requires deep payer experience and strong claims-data and financial modelling skills.
JOB DESCRIPTION SUMMARY
- Serve as actuarial SME for value-based care contracts with large health plans
- Model financial risk, reserves, and shared-savings/shared-risk arrangements
- Audit and standardize claims data analysis using Databricks and Excel
- Frequent client-facing work negotiating validation frameworks and guarantees
- San Francisco-based senior role requiring 8+ years in health insurance
DOMAIN EXPERTISE
- Claims data analysis for health insurers
- Pricing and underwriting for Medicare Advantage and ASO models
- Negotiating value-based care/shared-savings contracts
- Experience working with large payer organizations (Optum, UHG, Anthem)
- Familiarity with healthcare data warehouses (Databricks) and claims datasets
KEY REQUIREMENTS
- Bachelor's degree in Actuarial Science required
- 8+ years of experience in health insurance (pricing, claims, underwriting)
- Proven experience with large payer organizations and MA/ASO/fully insured models
- Advanced financial modelling in Excel and experience with claims data/Databricks
- Ability to present and negotiate with Chief Actuaries and C-suite stakeholders
TECH STACK
- Excel
- Databricks
- PowerPoint
