AVP, Managed Care Contracting, Medical Economics

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TriEdge Investments

WebsiteLinkedInAll Job Openings

11 - 50 employees

📋 Description

• 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

• 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

• 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.