Director, Actuarial Provider Network Analysis and Pricing

Judi Health • Denver, CO

2h • $156,400 - $234,500 • Hybrid

About The Position

Judi Health is a health technology company providing benefit administration solutions to employers, unions, health plans, and government entities. Judi Health replaces fragmented, outdated systems with the industry's first Unified Claims Processing™ architecture, seamlessly consolidating pharmacy and medical benefit administration on a single, secure platform. By delivering true price transparency, eliminating unnecessary middleman fees, and leveraging advanced AI-powered care delivery, Judi Health helps clients achieve unprecedented operational efficiency and service levels. At Judi Health, we're deploying the infrastructure our country needs to deliver the healthcare we all deserve. We are the intelligence platform powering benefits plans for millions of Americans and proudly leading the next generation of care. To learn more, visit www.judi.health.

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.

What This Job Offers

• Job Type: Full-time
• Career Level: Director