Value-Based Analyst

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

• Bachelors 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

• Masters 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