Senior Manager, Medical Economics/Medical Expense Actuary

At Devoted Health, we’re on a mission to dramatically improve the health and well-being of older Americans by caring for every person like family. That’s why we’re gathering smart, diverse, and big-hearted people to create a new kind of all-in-one healthcare company — one that combines compassion, health insurance, clinical care, service, and technology - to deliver a complete and integrated healthcare solution that delivers high quality care that everyone would want for someone they love. Founded in 2017, we've grown fast and now serve members across the United States.  And we've just started. So join us on this mission!

Job Description

A bit about this role: 

The Senior Manager of Medical Economics/Medical Expense Actuary will play a key role in supporting the organization's efforts to improve medical costs. This individual will collaborate with cross-functional teams to identify opportunities for cost optimization while maintaining high standards of quality and patient care. Working closely with various business areas (e.g., market leadership, payment integrity and claims, network, engineering, Devoted Medical), the actuarial team, and executive leadership, the Manager will contribute to key operational and strategic decisions. This role requires a strong foundation in healthcare economics, data analysis, and strategic planning, along with a solid understanding of healthcare delivery systems and reimbursement models. We're looking for someone with intellectual curiosity and a passion for driving results.

Your Responsibilities and impact will include:

• Medical Cost Analysis and Support: Support the identification, quantification, and tracking of activities related to medical expenses. This includes decomposing financial performance as it emerges and ensuring timely and accurate claims payments through collaboration with the Claims team.

• Provider Reimbursement Strategy: Partner with the network team to understand and quantify reimbursement terms and provide consultation and advice on provider and facility reimbursement strategies.

• Data-Driven Insights: Conduct in-depth analyses of healthcare utilization patterns, cost drivers, and performance metrics to identify areas for improvement and cost savings opportunities. This involves interpreting and analyzing clinical data from various sources to summarize observations and recommend actionable responses.

• Cross-Functional Collaboration: Partner closely with internal stakeholders, including clinical leadership, actuarial, accounting, finance operations, operations, network management, and local market teams, to support the development, execution, tracking, and management of strategies aligned with organizational goals. This includes providing expertise and consultation to advance capabilities in provider contracting, clinical program assessment, population health, payment integrity, provider reimbursement, and financial performance management.

• Financial Impact Assessment: Utilize analytical techniques, in collaboration with the finance, network, and/or data science teams, to forecast and evaluate the financial impact of proposed initiatives and interventions.

• Performance Monitoring: Monitor and evaluate the effectiveness of implemented initiatives through ongoing performance tracking and analysis, making data-driven recommendations for adjustments and improvements as needed.

• Industry Expertise: Stay informed about industry trends, regulatory changes, and best practices in healthcare economics and medical cost management, incorporating relevant insights into planning and decision-making, and seeking opportunities to translate those to Devoted Health.

• Reporting and Presentations: Prepare and present regular reports and presentations to leadership on the status of cost improvement initiatives, key performance indicators, and financial outcomes.

• Adherence to Core Values: Operate in accordance with Devoted's core values: Treat every member like family, Build for a rolling 20-year time horizon, Operate as a paragon of hypercompliance.

Required Skills and Experience:

• 5+ years of relevant experience in healthcare, with a strong focus on Government Programs, specifically Medicare Advantage, including expertise in provider reimbursement and medical economics.

• Solid functional expertise with an understanding of the key financial drivers of Medicare Advantage health plan operations.

• Highly analytical and hands-on, with the ability to be a contributor from day one and translate