Director, Payer Economics (Actuary)



Accounting & Finance
Bethesda, MD, USA
Posted on Wednesday, November 15, 2023
The Director, Payer Economics will apply a rigorous analytical approach to value-based care contracts, specifically focused on evaluating and managing and forecasting risk within Aledade’s Medicare Advantage, Commercial and Medicaid contracts. This person will develop actuarial models to evaluate potential financial impacts under a wide range of performance scenarios that will be an input to our reporting and disclosure processes and will inform risk evaluation and mitigation efforts across all of Aledade.
This role will support and report to the VP, Payer Economics on the Strategic Payer Partnerships team in leading the effort to develop more mature and formal actuarial and economic frameworks for evaluating value-based care contracts and deal terms, and translating high-level strategic targets and constraints into quantitatively defined perspectives on risk decision architecture across multiple lines of business. This role will also work closely with and support Aledade’s internal Finance and Performance teams.
We are flexible with respect to geographic location, and the ideal candidate will be comfortable working remotely within the US.

Primary Duties:

  • Develop and maintain an actuarial/economic framework for evaluating risk in value-based care contracts across MA, Commercial and Medicaid contracts
  • Identify risks that exceed specific thresholds and develop and present mitigation recommendations
  • Interface cross-functionally and perform analyses to fulfill the requirements of other Aledade teams

Minimum Qualifications:

  • 12+ years in healthcare with health plans, provider groups or consulting firms within value-based care and 8+ years doing healthcare actuarial analyses
  • Master’s degree or other advanced degrees in finance, economics, actuarial sciences, statistics, math or another quantitative field
  • Fellow of the Society of Actuaries (FSA) or Associate of the Society of Actuaries (ASA) designation

Preferred knowledge, skills, and abilities:

  • Data manipulation skills, including strong experience with Excel and working knowledge of SQL, as well as at least basic skills with Python, R, and/or other similar analytics-oriented programming
  • Experience with Google Workspace (Google Docs, Sheets, and Slides) as well as Microsoft Office (Word, Powerpoint, and Excel)
  • Knowledge of standard methods for measuring health care utilization, spending, quality, and outcomes; risk adjustment, provider profiling, and related analytical tasks
  • Strong ability to communicate actuarial concepts and results to a range of audiences including non-actuarial leaders and colleagues
  • Demonstrated ability to independently lead and execute complex, high-visibility projects with multiple stakeholders
  • Proven track record of creating, maintaining, and enhancing relationships and communicating effectively with senior management
  • Intense attention to detail and extraordinary commitment to assurance of data quality and integrity for important work products
  • Ability to think beyond their immediate team and contribute to making Aledade holistically better (active engagement in DE&I efforts, culture initiatives, facilitating training, leading roundtables, etc.)
  • Experience with MA mechanisms and industry structure, including familiarity with STARS, the MA bid process, and the basic economics of the MA market
  • Experience functioning in a highly matrixed organization and delivering complex, cross-functional projects
  • Experience developing and applying consistent analytical frameworks to contracts in the value-based care space
  • Experience in a fast-changing operational environment of a healthcare startup or similar
  • Experience successfully managing a team
  • Passionate about driving the shift from fee-for-service to value-based care and securing the future of independent primary care
  • Experience working with projections of premiums, costs, MLR, and other aspects of MA forecasting

Physical Requirements:

  • Sitting for prolonged periods of time. Extensive use of computers and keyboard. Occasional walking and lifting may be required.
  • Ability to travel
Who We Are:
Aledade, a public benefit corporation, exists to empower the most transformational part of our health care landscape - independent primary care. We were founded in 2014, and since then, we've become the largest network of independent primary care in the country - helping practices, health centers and clinics deliver better care to their patients and thrive in value-based care. Additionally, by creating value-based contracts across a wide variety of payers, we aim to flip the script on the traditional fee-for-service model. Our work strengthens continuity of care, aligns incentives, and ensures primary care physicians are paid for what they do best - keeping patients healthy. If you want to help create a health care system that is good for patients, good for practices and good for society - and if you're eager to join a collaborative, inclusive and remote-first culture - you've come to the right place.
What Does This Mean for You?
At Aledade, you will be part of a creative culture that is driven by a passion for tackling complex issues with respect, open-mindedness and a desire to learn. You will collaborate with team members who bring a wide range of experiences, interests, backgrounds, beliefs and achievements to their work - and who are all united by a shared passion for public health and a commitment to the Aledade mission.
In addition to time off to support work-life balance and enjoyment, we offer the following comprehensive benefits package designed for the overall well-being of our team members:
Flexible work schedules and the ability to work remotely are available for many roles
Health, dental and vision insurance paid up to 80% for employees, dependents, and domestic partners Robust time off plan 21 days of PTO in your first year 2 Paid Volunteer Days & 11 paid holidays
12 weeks paid Parental Leave for all new parents
6 weeks paid sabbatical after 6 years of service
Educational Assistant Program & Clinical Employee Reimbursement Program
401(K) with up to 4% match
Stock options
And much more!
At Aledade, we don’t just accept differences, we celebrate them! We strive to attract, develop, and retain highly qualified individuals representing the diverse communities where we live and work. Aledade is committed to creating a diverse environment and is proud to be an equal opportunity employer. Employment policies and decisions at Aledade are based on merit, qualifications, performance, and business needs. All qualified candidates will receive consideration for employment without regard to age, race, color, national origin, gender (including pregnancy, childbirth or medical conditions related to pregnancy or childbirth), gender identity or expression, religion, physical or mental disability, medical condition, legally protected genetic information, marital status, veteran status, or sexual orientation.
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