Job Description

Job Summary

This role is a senior leader responsible for advancing AbsoluteCare’s financial performance, value-based care strategy, and population health objectives through healthcare economics, strategic analytics, and executive decision support. The role serves as the primary Medical Economics partner and trusted advisor to Market Presidents and Executive Leadership, translating complex healthcare, financial, operational, clinical, membership, and payer data into actionable insights.

The Senior Director leads the Market Performance function, including total cost of care analytics, forecasting, shared-savings and risk-contract analytics, payer reconciliations, and executive decision support. This role serves as the organizational subject matter expert for the application of risk-adjustment and acuity methodologies within Medical Economics, including how population risk is measured and applied in forecasting, financial modeling, market-performance evaluation, and value-based contract analytics.

Duties and Responsibilities

Strategic and Market Performance Leadership

• Serve as a trusted advisor to Market Presidents and Executive Leadership.
• Lead market-level financial performance, total cost of care, utilization, revenue, quality, membership, and payer-performance evaluations.
• Lead market performance reviews that clarify results, outlook, risks, opportunities, and decisions required.
• Develop executive narratives and recommendations connecting financial results with clinical, operational, membership, contractual, and population-risk drivers.

Financial and Value-Based Care Analytics

• Lead forecasting, trend and seasonality analysis, claims completion methodologies, IBNR estimates, membership projections, and financial performance forecasts.
• Oversee analytics supporting shared savings, downside risk, risk-sharing arrangements, and other value-based payment models.
• Lead reconciliations involving claims, membership, eligibility, attribution, revenue, capitation, risk adjustment, and payer-reported performance.
• Serve as the organizational subject matter expert for the application of risk-adjustment and acuity methodologies within Medical Economics. Establish and maintain analytical approaches used to assess population risk, forecast performance, evaluate market acuity, and support value-based contract analytics.
• Partner with Quality and Risk Reporting leaders to maintain consistency between financial methodologies, quality-performance measurement, risk-adjustment reporting, population health analytics, and risk-recapture program reporting.
• Evaluate payer-reported results against contract provisions, underlying data, and established analytical methodologies.

Performance Improvement and Decision Support

• Partner with Market Presidents, Clinical Leadership, Operations, Finance, and Payer Operations to identify opportunities to improve outcomes, affordability, and financial performance.
• Analyze drivers across markets, populations, services, providers, and payer arrangements.
• Measure the impact of interventions and support ROI and investment decisions.

Analytics Modernization and Governance

• Advance forecasting, predictive analytics, automation, and appropriately governed AI-enabled decision support.
• Partner with Data Engineering, Information Technology, Finance, Payer Operations, and operational stakeholders to improve data quality and develop scalable analytical solutions.
• Establish consistent definitions, methodologies, documentation, peer review, quality controls, and governance processes.
• Reduce reliance on manual, duplicative, and person-dependent processes.

Team Leadership

• Recruit, lead, mentor, and retain a high-performing team of Medical Economics professionals.
• Develop senior analysts and managers to lead work independently and review the work of others.
• Build leadership depth, succession readiness, and a culture of accountability, collaboration, analytical rigor, and continuous improvement.

Minimum Qualifications

• Bachelor’s degree in economics, statistics, mathematics, actuarial science, finance, data science, public health, health administration, healthcare informatics, or a related field.
• Ten or more years of progressively responsible experience in Medical Economics, healthcare analytics, actuarial analytics, population health, payer analytics, provider analytics, or healthcare finance.
• Five or more years of experience leading analytical teams, people leaders, or senior analytical professionals.
• Experience with value-based care, shared savings, risk-sharing arrangements, total cost of care, or other alternative payment models.
• Strong knowledge of healthcare claims, membership, eligibility, utilization, provider, and financial data.
• Demonstrated ability to communicate complex analytical and financial findings to executive and nontechnical audiences and influence decisions across organizational boundaries.

Preferred Qualifications

• Master’s degree in relevant analytical, financial, healthcare, or business discipline.
• Experience with Medicaid, Medicare Advantage, dual-eligible populations, or provider-led value-based arrangements.
• Experience with forecasting, IBNR, claims completion, trend analysis, payer contract performance, settlements, and reconciliations.
• Strong understanding of risk-adjustment methodologies, population acuity measurement, healthcare reimbursement, and quality-performance programs, including application within financial forecasting, total cost of care analytics, and value-based payment arrangements.
• Experience with SQL, SAS, Python, R, Power BI, Tableau, or comparable analytical technologies.
• Experience with predictive modeling, automation, machine learning, or AI-enabled analytical solutions.

Working conditions

This job operates in a remote location from your home location. This role requires a dedicated, quiet workspace with the ability to adhere to HIPAA and other privacy policies. A reliable and high-speed Wi-Fi connection or home internet is required to perform the essential functions of this role.

Physical requirements

• Ability to communicate clearly and exchange accurate information constantly.
• Ability to remain stationary for long periods of time.
• Constantly computer, keyboard, copy and fax machine, phone and other general office equipment.
• Ability to occasionally move objects up to 20 lbs.

Direct reports

Director of Medical Economics, Manager, Data Analytics, Lead Data Analyst, Data Analyst