ESSENTIAL DUTIES and RESPONSIBILITIES:
- Build and lead Medical Economics team and broader capability
- Define roles to report to Medical Economics Direct; lead hiring and interviews, performance reviews and other employee experience practices
- Enhance and standardize medical cost trend analyses and benchmarking, collaborating with broader analytics team (for Quarterly Business Reviews with clients); define and disseminate associated processes and procedures
- Act as a thought-partner / consultant with brokers and groups to help them understand utilization outliers and changes to consider
- Lead Product Enhancements for medical management offerings requiring medical economics
- Build new and refine existing performance guarantees for various medical management offerings
- Develop alternative return-on-investment calculation methodologies for select offerings
- Develop and manage risk corridors
- Partner with select Stop Loss underwriters to share cost savings results
- Identify and lead efforts where analytics can further support clinical operations
- Educate clinical and sales teams on medical cost trends, new analytic capabilities, and product enhancements
- Attend industry forums / connect with peers to understand underlying macro trends and new therapies driving medical cost projections
- Share perspectives on new clinical offerings / enhancements with product and sales leaders
- Educate sales team on medical management product enhancements in-process and as completed
- Repeat client where we have made multiple placements
- Largest independent TPA for the Self Funded employer healthcare market
- The Company addresses the “dual mandate” to reduce costs and improve outcomes within the healthcare ecosystem. They offer core healthcare administrative services alongside a robust set of payment integrity and care management offerings to reduce costs, maximize efficiencies, and improve health outcomes for self-funded employer groups.
- They provide a single, integrated mobile app for managing benefits, communications that keep members informed and excited, about their business, and brings together services and integration points that power the benefits eco-system. They are looking to transform to become a holistic digitally integrated business.
- They have differentiated employee-centric model, high quality customer base, and demonstrated ability to reduce employer medical costs has resulted in a market-leading NPS score (80 compared to industry average of 14)
- They serve more than 430,000 members from 350 employers, across all 50 states. The organization has more than 675 employees and offices in California, Illinois, West Virginia and Pennsylvania.
- Their client base of 350 employer groups ranges from ~100 employees per client to 22,000 employees per client with an average client size of 1,000 employees.
- 3+ years of actuarial experience required, 2+ years of applicable product experience preferred
- Previous management experience including responsibilities for hiring, training, assigning work and managing performance of staff required
- Desire to be part of fast-growing and dynamic environment, interfacing directly with executive leadership
- Comfortable building and maintaining relationships with c-suite leaders of clients and brokers
Physical and Mental Requirements:
- Occasional travel (<10% annually)