Value-Based Analyst (Actuarial)

Role Overview

The Value-Based Analyst (Actuarial) supports financial analysis, forecasting, reimbursement modeling, and performance evaluation for US healthcare payer and value-based care arrangements. The role analyzes healthcare claims, reimbursement data, contract performance, and financial trends to support managed care negotiations, risk assessment, and strategic decision-making. Candidates must have direct US healthcare experience and a strong understanding of payer reimbursement, managed care, and value-based payment methodologies.

Key Responsibilities

Financial & Actuarial Analysis

• Develop financial models, forecasts, scenario analyses, and expected-versus-actual reimbursement analyses using healthcare claims and financial datasets.
• Analyze payer-specific performance, revenue trends, cost drivers, variances, and financial risks.
• Evaluate reimbursement methodologies, contract rate structures, shared-savings arrangements, and risk-based payment models.
• Apply analytical assumptions and actuarial concepts to support financial projections and contract performance assessments.

Value-Based Care & Contract Analytics

• Evaluate value-based contracts, including shared savings, quality incentives, risk corridors, and performance-based payment arrangements.
• Monitor contract performance, reimbursement accuracy, underpayments, and compliance with contractual terms.
• Support payer negotiations through financial impact assessments, sensitivity analyses, and scenario modeling.
• Analyze attribution, quality metrics, reconciliation results, and payment disputes to identify financial and operational opportunities.

Reporting & Business Insights

• Develop recurring financial reports, dashboards, forecasts, and executive-ready presentations.
• Use healthcare data and market intelligence to identify trends, assess risks, and support strategic recommendations.
• Build and improve analytical tools and methodologies for forecasting, performance monitoring, and financial reporting.
• Collaborate with Finance, Managed Care, and other stakeholders to translate complex analyses into actionable insights.

Required Qualifications & Experience

• Bachelor’s degree in a relevant field, such as Finance, Accounting, Economics, Actuarial Science, Data Analytics, or Healthcare Administration.
• At least 5 years of progressive experience in US healthcare finance, payer analytics, medical economics, healthcare consulting, or a closely related field.
• Direct US healthcare experience is mandatory, including familiarity with US payer systems, reimbursement practices, claims data, or managed care arrangements.
• Demonstrated knowledge of payer reimbursement methodologies, such as DRG, APC, fee schedules, and value-based payment models.
• Experience developing financial models, forecasts, scenario analyses, and contract performance assessments.
• Strong analytical capabilities and experience working with large healthcare claims, reimbursement, or value-based performance datasets.
• Advanced proficiency in SQL, Power BI, Tableau, or comparable analytical and visualization tools.
• Strong communication skills, with the ability to present complex financial findings to technical and non-technical stakeholders.

Preferred Qualifications

• Master’s degree in Business Administration, Healthcare Administration, Public Health, Finance, or a related discipline.
• Certified Healthcare Financial Professional (CHFP) or Certified Professional in Healthcare Quality (CPHQ).
• Experience with payer negotiations, revenue cycle operations, or managed care contracting.
• Familiarity with actuarial concepts such as Incurred But Not Reported (IBNR), risk-based arrangements, and shared-savings models.
• Knowledge of US government healthcare programs, including Medicare Advantage and Medicaid, and HCC risk adjustment methodologies.
• Experience with healthcare analytics platforms such as Epic, Strata, or EPSi.
• Experience mentoring analysts or improving analytical standards and processes.

Key Skills & Tools

• US Healthcare Payer & Reimbursement Analytics
• Value-Based Care & Managed Care Contracting
• Financial Modeling, Forecasting & Scenario Analysis
• Healthcare Claims & Performance Data
• Actuarial Concepts & Risk Assessment
• SQL, Power BI & Tableau
• Contract Reconciliation & Variance Analysis
• Executive Reporting & Stakeholder Communication