Director, Actuarial Provider Network Analysis and Pricing

Judi Health•Charlotte, NC

3d•Hybrid

About The Position

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.

Requirements

Bachelors degree in mathematics or related field.
Minimum eight (8) years actuarial experience.
Additional equivalent work experience in a directly related field may be substituted for the degree requirement.
Associate of the Society of Actuaries or Fellow of the Society of Actuaries.

Nice To Haves

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

Responsibilities

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.
Coordinates, performs modeling and presents analyses to influence our negotiation strategy for contracts including, 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).
Lead the the efforts to price and quantify impact of provider tiering, episode level, and other network innovations that will drive higher quality and affordability, rolling up to employer group pricing.
Partners with the provider contracting and delivery system teams to develop network strategy and tools to support their negotiations.
Influences senior business partners by translating complex actuarial constructs into actionable recommendations; and initiating actuarial and financial advice in compliance with the Actuarial Standards of Practice.
Identifies needs and provides guidance on how to build framework and assumptions for new, existing, and non-traditional actuarial models to meet business needs.
Partner with underwriting to model and price innovative benefit plan design that leverages network strategy.