Value-Based Expert

Intro Recruitment Asia; Taguig; Híbrido; PHP 1 000 000 - 1 800 000; Tempo integral

Vantagens oferecidas por esta oferta de emprego

Health coverage

Retirement plan with employer match

Paid time off and holidays

Professional development support

Resumo da oferta

Intro Recruitment Asia seeks a Value-Based Expert to lead financial and analytical work behind our managed care contracting and value-based payment strategy. You will turn complex claims and performance data into insights informing payer negotiations and enterprise decisions.

The role includes designing value-based payment models, monitoring contract performance, auditing payer compliance, and mentoring a team of Managed Care Analysts.

Qualificações

• Bachelor's degree in STEM or related field.
• 5+ years in healthcare finance or payer analytics.
• Proven analytics driving business decisions.
• Experience with value-based contracts and QA/audit processes.

Responsabilidades

• Prepare analyses to support managed care negotiations.
• Synthesize payer data, market trends for strategy.
• Design value-based payment models including risk and attribution.
• Develop financial forecasts and stress tests.
• Monitor program performance and compliance.
• Create executive visualizations and scalable analytics.
• Mentor analysts and drive process improvements.

Conhecimentos

SQL

Tableau

Power BI

Forecasting

Data analysis

Contract negotiations

Value-based models

Communication

Leadership

Formação académica

Bachelor's degree in STEM or related field

Ferramentas

Tableau

Power BI

Descrição da oferta de emprego

We are seeking a Value-Based Expert to lead the financial and analytical work behind our managed care contracting and value-based payment strategy. In this role, you will turn complex claims, reimbursement, and performance data into clear insights that shape payer negotiations and enterprise decisions. You will design and evaluate value-based payment models, monitor contract performance, audit payer compliance, and mentor a team of Managed Care Analysts.

Key Responsibilities

Contract Negotiation Support

• Prepare advanced reimbursement, financial impact, and performance analyses to support managed care contract negotiations and payer strategy.
• Synthesize insights from payer data, market trends, and industry developments to inform negotiation strategy and enterprise decision-making.

Value-Based Model Design

• Design and evaluate value-based payment models, including shared savings, quality metrics, risk corridors, and attribution methodologies.

Financial Modeling and Forecasting

• Conduct pro forma and sensitivity analyses to estimate the financial value of proposed contract changes, cost containment initiatives, and industry trends.
• Perform stress testing under multiple utilization and cost scenarios to understand the range of potential outcomes.
• Develop monthly forecasts and financial packages summarizing value-based performance, payment reconciliation, and variance analysis.
• Develop and implement innovative tools and methodologies to monitor healthcare trends and accurately forecast value-based performance.

Performance Monitoring and Compliance

• Monitor and analyze contract and value-based program performance, identifying underpayments, compliance gaps, unfavorable payment trends, and financial risks.
• Conduct quarterly and annual reconciliation audits for value-based programs, ensuring payer compliance with contractual terms and identifying areas of non-compliance that affect contract performance.

Reporting and Visualization

• Create executive-ready visualizations of contract performance and financial forecasts, tailored to different audiences (clinical vs. financial).
• Build repeatable analytic processes that scale across programs.
• Mentor Managed Care Analysts and provide technical guidance.
• Contribute to analytical standards and process improvements within the team.

Required Qualifications

• Bachelor's degree in a STEM or related field, such as Economics, Actuarial Science, Health Economics, Business Administration, Finance, Accounting, or Healthcare Administration.
• 5+ years of progressive experience in healthcare finance, payer analytics, medical economics, or healthcare consulting.
• Demonstrable track record of building analytics that drive business decisions and actions.
• Demonstrated experience supporting value-based contract development, including performance measurement, attribution and quality metrics, reconciliation, and dispute resolution/appeals processes.
• Experience with forecasting, audit, and predictive analytics to support negotiation and contract performance management.
• Advanced proficiency in SQL and Tableau and/or Power BI, with demonstrated experience extracting, validating, and analyzing large healthcare claims, reimbursement, and/or value-based performance datasets.
• Strong communication skills, with the ability to translate complex data into strategic insights for both technical and non-technical audiences.

Preferred Qualifications

• Master's degree in MBA, MHA, MPH, Finance, or a related field.
• Certified Professional in Healthcare Quality (CPHQ), NAHQ.
• Familiarity with actuarial concepts such as IBNR and financial reporting under shared-savings or risk-based arrangements.
• Deep understanding of CMS programs (Medicare Advantage, Medicaid) and HCC risk adjustment methodologies.
• Deep expertise in managed care contract structures, reimbursement methodologies, and value-based payment models.

What We Offer

• Comprehensive health, dental, and vision coverage
• Retirement plan with employer match
• Paid time off and holidays
• Professional development support, including certification and conference funding
• hybrid flexibility

Intro Recruitment Asia is an equal opportunity employer. We welcome applicants of all backgrounds and do not discriminate on the basis of race, color, religion, sex, national origin, age, disability, veteran status, sexual orientation, gender identity, or any other protected characteristic.