Value-Based Analyst (Actuarial)

PM Consulting; Pasig; On-site; PHP 900,000 - 1,500,000; Full time

Job summary

PM Consulting in the Philippines seeks a Value-Based Analyst (Actuarial) to support financial analysis, forecasting, and reimbursement modeling for US healthcare payer arrangements. The role requires direct US healthcare experience.

You will analyze claims data, contract performance, and value-based payments, build models, and deliver insights to stakeholders. Strong SQL/BI skills and communication are essential.

Qualifications

• Bachelor’s degree or higher in Finance, Accounting, Economics, Actuarial Science, Data Analytics, or Healthcare Administration.
• At least 5 years in US healthcare finance, payer analytics, medical economics, healthcare consulting, or related field.
• Direct US healthcare experience is mandatory, including familiarity with payer systems and reimbursement practices.
• Knowledge of payer reimbursement methodologies (DRG, APC, fee schedules) and value-based models.
• Experience building financial models, forecasts, and contract performance assessments.
• Proficient with large healthcare claims data and analytics tools.
• Strong communication for presenting complex findings to varied stakeholders.
• Preferred: Master’s degree or CHFP/CPHQ and familiarity with Epic/Strata/EPSi.

Responsibilities

• Develop financial models, forecasts, and scenario analyses using healthcare data.
• Evaluate contract performance, reimbursement structures, and risk-based payment models.
• Support negotiations with financial impact assessments and sensitivity analyses.
• Produce recurring financial reports and executive-ready dashboards.

Skills

US Healthcare Payer Analytics

Value-Based Care Analytics

Financial Modeling

SQL

Power BI

Tableau

Contract Reconciliation

Executive Reporting

Education

Bachelor’s degree in Finance, Accounting, Economics, Actuarial Science, Data Analytics, or Healthcare Administration

Tools

Epic

Strata

EPSi

Job description

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

• Bachelor’s 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

• Master’s 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