Health Economist

Hinge Health • San Francisco, CA

26d

About The Position

Hinge Health is transforming how millions of people access musculoskeletal (MSK) care—and we need an exceptional Actuary to help us prove it. As digital health moves from wellness benefit to medical insurance product, your actuarial expertise will be the bridge between our clinical innovation and the $1B+ MSK market. You'll serve as our primary subject matter expert facing the Chief Actuaries at BUCA plans, ACOs, and Integrated Health Systems—defending our ROI methodologies, negotiating performance guarantees, and shaping the future of value-based care contracts that put our business model at risk and reward.
What You'll Accomplish
In your first 3 months:
Establish credibility with internal stakeholders (Sales, Finance, Customer Success) by conducting training on actuarial concepts like PMPM benchmarks, matched cohort designs, and performance guarantee modeling
Audit our current Business Case Analysis (BCA) templates and ROI methodologies to identify gaps and quick wins
Shadow 2-3 finalist meetings with prospective health plan clients to understand the sales cycle and buyer objections
In your first 6 months:
Lead technical discussions with external actuarial teams during finalist meetings, successfully negotiating mutually agreeable validation frameworks for at least one "at-risk" contract
Design and standardize our Enhanced Claims Data Analysis (CDA) methodology, defining data requirements (e.g., unit costs, service categories) that ensure defensible hard-dollar savings
Model the financial risk and reserve requirements for our first shared-savings/shared-risk arrangement, presenting recommendations to the CFO and Clinical Research Director
In your first year:
Serve as the primary Actuarial SME on 5+ finalist presentations, directly contributing to securing key health plan contracts by gaining actuarial buy-in
Shape Hinge Health's transition to a value-based care provider by designing risk-transfer models and VBC contracting terms for new product lines (e.g., HingeSelect, Medicare Advantage pairings)
Represent Hinge Health at industry events (e.g., SOA Health Conference) and contribute thought leadership on digital health economics

Requirements

• Bachelor's Degree in Actuarial Science (required); Fellow of the Society of Actuaries (FSA) and Member of the American Academy of Actuaries (MAAA) strongly preferred
• 8-10+ years of experience in health insurance, with deep expertise in claims data analysis, pricing, and underwriting
• Proven experience working with large payer organizations (e.g., Optum, UHG, Anthem, BCBS plans) and navigating Medicare Advantage, Fully Insured, and ASO financial models
• Advanced proficiency in financial modeling (Excel) and data analysis tools; familiarity with healthcare data warehouses (e.g., Databricks) and claims datasets

Nice To Haves

• Experience designing and negotiating value-based care contracts or shared-savings/shared-risk arrangements in digital health or MSK care
• Familiarity with AI tools (e.g., Claude, GitHub Copilot) and willingness to develop AI-assisted actuarial modeling expertise
• Track record of thought leadership (e.g., SOA conference presentations, published articles on digital health economics)
• Exceptional ability to influence C-suite executives and Chief Actuaries at large health plans without formal authority

Responsibilities

• Establish credibility with internal stakeholders (Sales, Finance, Customer Success) by conducting training on actuarial concepts like PMPM benchmarks, matched cohort designs, and performance guarantee modeling
• Audit our current Business Case Analysis (BCA) templates and ROI methodologies to identify gaps and quick wins
• Shadow 2-3 finalist meetings with prospective health plan clients to understand the sales cycle and buyer objections
• Lead technical discussions with external actuarial teams during finalist meetings, successfully negotiating mutually agreeable validation frameworks for at least one "at-risk" contract
• Design and standardize our Enhanced Claims Data Analysis (CDA) methodology, defining data requirements (e.g., unit costs, service categories) that ensure defensible hard-dollar savings
• Model the financial risk and reserve requirements for our first shared-savings/shared-risk arrangement, presenting recommendations to the CFO and Clinical Research Director
• Serve as the primary Actuarial SME on 5+ finalist presentations, directly contributing to securing key health plan contracts by gaining actuarial buy-in
• Shape Hinge Health's transition to a value-based care provider by designing risk-transfer models and VBC contracting terms for new product lines (e.g., HingeSelect, Medicare Advantage pairings)
• Represent Hinge Health at industry events (e.g., SOA Health Conference) and contribute thought leadership on digital health economics

Benefits

• Inclusive healthcare and benefits: Comprehensive medical, dental, and vision coverage, plus support for gender-affirming care, family and fertility planning, and travel reimbursements if healthcare isn't available where you live
• Planning for the future: Traditional or Roth 401k retirement plan options with a 2% company match
• Modern life stipends: Manage your own learning and development, wellness, and lifestyle needs

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Number of Employees: 501-1,000 employees