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AVP, Managed Care Contracting, Medical Economics
TriEdge InvestmentsLead Managed Care Contracting & Medical Economics unit at Salud Healthcare, transforming value-based care through data-driven insights and technology. Conduct quantitative analysis and engage with payor partners.
About the role
Key responsibilities & impact- Apply quantitative analysis to underwrite risk across various value-based care contracts, including but not limited to P4Q, professional fee capitation, two-sided shared savings models, and global capitation arrangements.
- A strong understanding of healthcare terminology and principles, including medical coding, claims data, and broader medical economic trends, including Part A, B, and D segments.
- Strong proficiency in being able to use databases and tools to query, interpret, and build sensitivity models to evaluate risk propensity.
- Ability to take claims data and develop IBNR models to inform a prediction of future paid claims experience.
- Partner cross-functionally with internal stakeholders on legal implications of managed care negotiations, financial forecasting and budgeting, and operational delivery tactics.
- Effective verbal, written, and presentation skills to wide audiences, including physicians, executive management, and external stakeholders.
- Responsible for participating in payor JOC meetings to facilitate alignment on performance targets and goals.
Requirements
What you’ll need- Bachelor’s degree (B.A.) in actuarial science, healthcare economics, quantitative analysis, mathematics, or a closely related field; a statistics background would prove helpful in this role
- Experienced healthcare economist or actuary with a payor or benefits consultant background.
- ASA or FSA designation required, or progress towards such designations.
- Experience in client-facing roles
- Strong analytical abilities and proficiency with Microsoft Office, especially Word, Excel, and PowerPoint.
- Experience across different health insurance products is highly preferred, including: Medicare, Medicaid, commercial, and exchange lines of business.
Benefits
Comp & perks- Health, dental, and vision insurance.
- 401(k)
- Paid time off and company holidays.
- Opportunity to shape the future of healthcare technology within a rapidly growing value-based care organization.
ATS Keywords
✓ Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
quantitative analysisrisk underwritingmedical codingclaims data analysisIBNR modelssensitivity modelsfinancial forecastingbudgetinghealthcare economicsactuarial science
Soft Skills
effective communicationpresentation skillsanalytical abilitiescross-functional collaborationclient-facing experience
Certifications
ASA designationFSA designation