Judi Health is a health technology company providing benefit administration solutions to employers, unions, health plans, and government entities. Judi Health replaces fragmented, outdated systems with the industry's first Unified Claims Processing™ architecture, seamlessly consolidating pharmacy and medical benefit administration on a single, secure platform. By delivering true price transparency, eliminating unnecessary middleman fees, and leveraging advanced AI-powered care delivery, Judi Health helps clients achieve unprecedented operational efficiency and service levels.
At Judi Health, we're deploying the infrastructure our country needs to deliver the healthcare we all deserve. We are the intelligence platform powering benefits plans for millions of Americans and proudly leading the next generation of care. To learn more, visit www.judi.health.
Location: Hybrid (3 days per week in our NYC, Denver or Charlotte offices)
Position Summary
The Director, Actuarial Provider Network Analysis and Pricing is part of the growing Judi Care Actuarial and Underwriting team, which partners with the network team to ensure our contract negotiations, network strategy, and understanding of our network performance are informed by reliable data and modeling. This role serves as the team lead and is a leadership level role that will engage regularly with network, sales, and underwriting leadership. This is the initial team member focused on provider network analysis and will work alongside Actuarial and Underwriting leadership to build out the team. The work will require knowledge and experience of pricing, provider contracting, network strategy, and how they impact unit cost and overall trends and product & network financial performance.
Position Responsibilities:
- Network analytics infrastructure: Lead and own the build out infrastructure to leverage market and transparency data for contract analysis with an ultimate focus on total cost of care.
- Negotiation strategy support: Coordinates, performs modeling and presents analyses to influence our negotiation strategy for contracts including, but not limited to, fee for service, bundles, and capitation. Considers impact of network composition changes (i.e. removal or addition of network providers with transition to other providers and sites of care).
- Pricing analysis: Lead the the efforts to price and quantify impact of provider tiering, episode level, and other network innovations that will drive higher quality and affordability, rolling up to employer group pricing.
- Network strategy analysis: Partners with the provider contracting and delivery system teams to develop network strategy and tools to support their negotiations.
- Actuarial professional responsibilities: Influences senior business partners by translating complex actuarial constructs into actionable recommendations; and initiating actuarial and financial advice in compliance with the Actuarial Standards of Practice.
- Actuarial models: Identifies needs and provides guidance on how to build framework and assumptions for new, existing, and non-traditional actuarial models to meet business needs.
- Benefit design and pricing: Partner with underwriting to model and price innovative benefit plan design that leverages network strategy.
Required Qualifications:
- Bachelors degree in mathematics or related field.
- Minimum eight (8) years actuarial experience.
- Additional equivalent work experience in a directly related field may be substituted for the degree requirement.
- Associate of the Society of Actuaries or Fellow of the Society of Actuaries.
Preferred Qualifications:
- Four (4) years experience in a leadership role with or without direct reports.
- Five (5) years experience with provider contracting analysis.
- Programming (SQL, SAS, Python, R) experience.
All employees are responsible for adherence to the Judi Health Code of Conduct including the reporting of non-compliance. This position description is designed to be flexible, allowing management the opportunity to assign or reassign duties and responsibilities as needed to best meet organizational goals.
We provide equal employment opportunities to all employees and applicants for employment and prohibit discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, medical condition, genetic information, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.
By submitting an application, you agree to the retention of your personal data for consideration for a future position at Judi Health. More details about Judi Health's privacy practices can be found at https://www.judi.health/legal/privacy-policy.
Skills Required
- Bachelor's degree in mathematics or a related field, or equivalent directly related work experience
- At least 8 years of actuarial experience
- Associate of the Society of Actuaries or Fellow of the Society of Actuaries
- Four years of leadership experience, with or without direct reports
- Five years of provider contracting analysis experience
- Programming experience with SQL, SAS, Python, or R
What We Do
Judi Health is a health technology company providing a comprehensive suite of solutions for employers and health plans, including: - Capital Rx: a public benefit corporation delivering full-service pharmacy benefit management (PBM) solutions to self-insured employers - Judi Health™: full-service health benefit management for employers, TPAs, and health plans - Judi®: a single, scalable SaaS solution that health plans can utilize to manage all their claim workflows Through these solutions, Judi Health is executing on its mission to give our country the infrastructure it needs for the healthcare we deserve. To learn more, visit www.judi.health.
