Director of Medical Economics & Value-Based Forecasting

Complete Health; Jacksonville (FL); Hybrid; USD 180,000 - 260,000; Full time

Job summary

Complete Health, based in Jacksonville, FL, seeks a Director of Medical Economics to lead cost forecasting, reserving, risk adjustment analytics, and healthcare economics across Medicare Advantage and value-based care programs. You will partner with Actuarial, Finance, Population Health, and Leadership teams to drive performance and strategic decisions.

The ideal candidate has a strong actuarial foundation, ASA designation, and extensive experience in RAF accruals, IBNR, and healthcare cost

Qualifications

• ASA designation required.
• Bachelor's degree in Actuarial Science, Mathematics, Statistics, Economics, Finance, or related quantitative discipline.
• 8+ years of experience within Medical Economics, Actuarial, Healthcare Analytics, Medicare Advantage, or Risk Adjustment.
• RAF accruals, IBNR methodologies, Medical cost forecasting, budgeting & financial planning, value-based care analytics, healthcare economics.
• Strong proficiency with SQL and healthcare data analysis.
• Proven ability to communicate complex analytical findings to executive stakeholders.
• Prior experience leading teams and cross-functional initiatives.

Responsibilities

• Lead development and oversight of monthly Value-Based Care reserving, forecasting, and budgeting processes.
• Own methodologies and reporting associated with IBNR reserves and RAF accruals.
• Utilize CMS SAS software to support risk adjustment analytics and RAF forecasting.
• Track, analyze, and project medical expense and utilization trends, identifying opportunities and risks across the business.
• Develop forecasts and financial models supporting Medicare Advantage and value-based care performance.
• Partner with Finance and Actuarial teams on monthly close processes, budgeting, and long-range financial planning.
• Build and maintain scalable analytical solutions utilizing SQL and large healthcare datasets.
• Perform deep-dive analyses on medical cost, utilization, provider performance, and value-based contract outcomes.
• Present findings and strategic recommendations to executive leadership.
• Lead, mentor, and develop high-performing analytics and medical economics team members.

Skills

Leadership

Executive communication

Team management

SQL

Financial forecasting

Education

ASA designation

Bachelor's degree in Actuarial Science, Mathematics, Statistics, Economics, Finance, or related quantitative discipline

Tools

SQL

Power BI

Tableau

Job description

Complete Health, based in Jacksonville, FL, seeks a Director of Medical Economics to lead cost forecasting, reserving, risk adjustment analytics, and healthcare economics across Medicare Advantage and value-based care programs. You will partner with Actuarial, Finance, Population Health, and Leadership teams to drive performance and strategic decisions.

The ideal candidate has a strong actuarial foundation, ASA designation, and extensive experience in RAF accruals, IBNR, and healthcare cost