Director, Actuarial Provider Network Analysis and Pricing

Location:Hybrid (3 days per week in our NYC, Denver or Charlotte offices)

Position Summary

The Director, Actuarial Provider Network Analysis and Pricing is part of the growing Judi Care Actuarial and Underwriting team, which partners with the network team to ensure our contract negotiations, network strategy, and understanding of our network performance are informed by reliable data and modeling. This role serves as the team lead and is a leadership level role that will engage regularly with network, sales, and underwriting leadership. This is the initial team member focused on provider network analysis and will work alongside Actuarial and Underwriting leadership to build out the team. The work will require knowledge and experience of pricing, provider contracting, network strategy, and how they impact unit cost and overall trends and product & network financial performance.

Position Responsibilities:

• Network analytics infrastructure: Lead and own the build out infrastructure to leverage market and transparency data for contract analysis with an ultimate focus on total cost of care.
• Negotiation strategy support: Coordinates, performs modelingand presentsanalyses to influence our negotiation strategy for contractsincluding, but not limited to, fee for service, bundles, and capitation.Considers impact of network composition changes(i.e.removal or addition of network providers with transition to other providers and sites of care).
• Pricing analysis: Lead the the efforts to price and quantifyimpactof provider tiering, episode level, and other network innovations that will drive higher quality and affordability, rolling up to employer group pricing.
• Network strategy analysis: Partnerswith theprovidercontracting and delivery system teams to develop network strategyand tools to support their negotiations.
• Actuarial professional responsibilities:Influences senior business partners by translating complex actuarial constructs into actionable recommendations; andinitiatingactuarial and financial advice in compliance with the Actuarial Standards of Practice.
• Actuarial models:Identifies needs and provides guidance on how to buildframeworkand assumptions for new, existing, and non-traditional actuarial models to meet business needs.
• Benefitdesign and pricing: Partner with underwriting to model and price innovative benefit plan design thatleveragesnetwork strategy.

Required Qualifications:

• Bachelors degree in mathematics or related field.
• Minimum eight (8) years actuarial experience.
• Additionalequivalent work experience ina directly relatedfield may be substituted for thedegreerequirement.
• Associate of the Society of Actuaries or Fellow of the Society of Actuaries.

Preferred Qualifications:

• Four (4)years experiencein a leadership role with or without direct reports.
• Five(5)years experiencewithprovider contracting analysis.
• Programming (SQL, SAS, Python, R) experience.