Advisor, Value- Analytics & Strategic Deal Management

Job Summary

We are seeking a data-driven strategist with a deep understanding of how health plans manage spend, utilization, and risk. In this individual contributor role, you will be the primary architect of our value-based contracting engine. You will bridge the gap between health plan utilization data and strategic financial partnerships. Your primary focus will be to transform complex datasets into sophisticated capitated and risk-based deal models.

This role is critical to our growth, as you will provide the financial evidence and strategic modeling necessary to secure innovative partnerships with national and regional health plans.

Responsibilities

• Deal Modeling & Architecture – Design and build sophisticated financial models to support the transition from Fee-for-Service (FFS) to capitated (PMPM) and shared risk arrangements with health plans.

• DME-Specific Actuarial Trends – Apply adjustments to historical claims data that account for DME-specific variables and HCPCS-level inflation trends to ensure model accuracy.

• Risk Scoring & Stratification – Develop and implement member-level risk scoring models, allowing the organization to identify high-utilizers and price risk accurately within a population. Conduct sensitivity analyses and "stress tests" on proposed deal structures to contemplate various risk scenarios.

• Leakage & Network Analysis – Analyze "out-of-network" spend patterns to identify opportunities for volume consolidation, providing the data to justify exclusivity within the risk-based contract.

• Strategic Proposal Development – Translate complex modeling outputs into executive-level financial proposals.

• Cross-functional Collaboration – Partner closely with Sales, Marketing, and Finance to ensure deal models align with operational capabilities and long-term company strategy.

• Value-Based Care Innovation – Partner with internal teams to model the financial impact of clinical interventions (ex: remote patient monitoring) on the overall risk-based contract performance.

Qualifications

• Bachelor's degree in related field, or equivalent work experience, preferred

• Minimum of 5 years of experience specifically focused on deal management, actuarial analysis, or complex financial modeling within the healthcare sector preferred

• Understanding of the DME lifecycle, including HCPCS coding and how supply/equipment utilization (ex: continuous glucose monitors) impacts total medical spend.

• Experience supporting or leading the financial portion of executive-level contract negotiations, with the ability to defend modeling assumptions.

• Professional proficiency in managing large-scale utilization and census data.

• Expert-level Excel skills, including the ability to build automated, dynamic "what-if" scenario engines that contemplate varying levels of risk and utilization.

• Hands-on experience applying risk-adjustment methodologies (ex: CMS-HCC or proprietary scoring) to predict the future healthcare costs of a patient (or population) based on their demographic profile.

• Proven ability to apply medical cost trends, seasonality adjustments, and "Incurred But Not Reported" (IBNR) logic to historical data to project future liability.

• Understanding of Medicare/Medicaid reimbursement landscapes and how regulatory changes impact long-term risk-based deal viability.

• Preferred:
  Direct experience working within a health plan’s actuarial, medical economics, finance, or network contracting department. You should understand "the other side of the table"—how payers evaluate PMPM costs and utilization.

What is expected of you and others at this level

• Applies comprehensive knowledge and a thorough understanding of concepts, principles, and technical capabilities to perform varied tasks and projects

• May contribute to the development of policies and procedures

• Works on complex projects of large scope

• Develops technical solutions to a wide range of difficult problems

• Solutions are innovative and consistent with organization objectives

• Completes work; independently receives general guidance on new projects

• Work reviewed for purpose of meeting objectives

• May act as a mentor to less experienced colleagues

Anticipated salary range: $80,900 - $103,950

Bon…