Director, Health Plan Economics

Alignment Health is breaking the mold in conventional health care, committed to serving seniors and those who need it most: the chronically ill and frail. It takes an entire team of passionate and caring people, united in our mission to put the senior first. We have built a team of talented and experienced people who are passionate about transforming the lives of the seniors we serve. In this fast-growing company, you will find ample room for growth and innovation alongside the Alignment Health community. Working at Alignment Health provides an opportunity to do work that really matters, not only changing lives but saving them. Together.

The Director of Health Plan Economics drives the health plan’s risk stratification, predictive modeling, and financial analytics agenda—translating data into operational action, governing metric definitions, building predictive KPIs and tools, and leading a high‑performing analytics team to improve quality, affordability, and performance across value‑based programs.

General Duties/Responsibilities (May include but are not limited to):

• Develop and maintain risk‑stratification frameworks to identify high‑risk and emerging‑risk members for care management, utilization management, and disease management programs.
• Build and refine predictive models for hospitalization, readmissions, ED utilization, progression of chronic disease, and care gap closure.
• Translate model outputs into actionable insights for clinical operations, network management, and product teams.
• Evaluate medical cost trends with clear decomposition of unit cost, utilization, service mix, and demographic drivers.
• Quantify financial risk across populations, benefit designs, provider arrangements, and value‑based care programs.
• Conduct deep‑dive analyses into cost containment opportunities, high‑cost cohorts, and avoidable utilization.
• Partner with Utilization Management and Clinical Operations to reconcile authorization, admission, and bed‑day data with paid claims; ensure accuracy and consistency of operational metrics.
• Lead or participate in cross‑functional governance of measure definitions to align IT, Finance, Clinical, and Operational areas.
• Develop predictive KPIs and operational forecasts to support proactive business management.
• Prototype data pipelines, dashboards, and analytical tools to support evolving business needs.
• Work hands‑on with medical and pharmacy claims data to validate assumptions, troubleshoot anomalies, and uncover business insights.
• Promote best practices in data quality, metadata management, and analytic reproducibility.
• Lead cross‑functional analytic initiatives, ensuring alignment with organizational strategy and CMS program requirements.
• Provide coaching, mentorship, and technical training to analytics staff.
• Address performance gaps, support professional development, and uphold team accountability standards.
• Perform other duties as required to support the broader health plan economics and analytics agenda.

Supervisory Responsibilities:

Oversees assigned staff. Responsibilities include recruiting, selecting, orienting, and training employees; assigning workload; planning, monitoring, and appraising job results; and coaching, counseling, and disciplining employees.

Minimum Requirements:

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily.The requirements listed below are representative of the knowledge, skill, and/or ability required.Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Minimum Experience:

At least 10 years of experience in healthcare analytics, medical economics, actuarial/financial analysis, or a related field.

At least 10 years of managerial experience

Education/Licensure:

Bachelor of Science in Business required

Other: Advanced proficiency working with claims (medical, pharmacy) and enrollment data for trend analysis, forecasting, and predictive modeling. Experience with rigorous program evaluation techniques (e.g., propensity score matching, inverse probability weighting, differences‑in‑differences). Strong command of predictive modeling tools and statistical methods; SQL required, Python or R strongly preferred. Deep understanding of CMS Medicare Advantage payment methodologies (RAF, risk adjustment, benchmarks, STARS, etc.). Familiarity with provider contracting strategies, value‑based care economics, and population health models. Expertise in risk stratification, utilization patterns, and cost containment strategies. Demonstrated success leading analytics teams and gui