The Head of Actuarial Sciences is critical to the success of this endeavor and will work closely with the Chief Financial Officer (CFO), Chief Clinical Officer (CCO), and Business Development Team, to oversee all aspects of H3’s Actuarial function.
- Oversees and manages a team in conducting complex analysis in support of pricing and total cost of care (TCOC) performance
- Conducts analysis, pricing and risk assessment, including understand cost of care for a population, calculating medical cost trend, to estimate financial outcomes across the portfolio of offers under different fee arrangements (PMPM with performance guarantees, partial and full risk) .
- Develops and maintains the company's tools for measuring profitability and risk exposures related to medical cost
- Promotes best practices across the company and ensures the integrity of the organization's pricing and engages with clinical and care management functions to identify medical cost savings initiatives
- Supports the design and execution of risk-based commercial arrangements by:
- Understanding the baseline cost drivers and clinical profile of potential target populations
- Understanding the opportunity for improvement in medical costs and healthcare outcomes for potential target populations
- Identifying and quantifying potential interventions and opportunity for to establish programs, services, or solutions with potential target populations
- Modelling the impact of specific programs on potential healthcare costs and outcomes of the target populations under different potential delegated risk model scenarios (e.g., shared savings, cap, sub-cap) in specific markets, with specific partners
- Recommending optimal delegated risk-arrangements that maximize potential value creation while appropriately managing risk of financial outcomes
- moves to risk-based arrangements with clients set up systems and processes to develop medical cost reserves.
- Supports the pricing of solutions in other commercial arrangements by estimating the value created by solutions for potential target populations on specific markets with specific partners
- Assesses the quality / impact of potential external parties (e.g., capability or enablement partners, M&A targets) against the medical costs based on empirical data provided by those partners
- Maintains awareness of enacted and proposed legislation at the federal and state level and uses this information in the completion of the above activities
Very competitive salary and benefits!
Great company to work for!
Full relocation package is available!
Don't miss out! Apply now and we'll be in touch immediately with more specific details, salary information and to answer any questions!!
This position does NOT provide sponsorship so please do NOT apply if you require sponsorship. Thank You
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