Senior Medical Cost & Value Architect

Devoted; United States; Remote; USD 175,000 - 250,000; Full time

Benefits offered by this job

Health, dental and vision plan

Generous paid time off

Stock options

401K program

Parental leave

Job summary

Devoted Health seeks a Medical Economist to lead strategic contracting and reimbursement design across Commercial networks in the United States. You will model financial impacts, oversee complex provider agreements, and partner with IT and Claims teams to ensure accurate adjudication and cost optimization.

You will drive analytics on Total Medical Expense trends, price, utilization, and mix, delivering executive-ready insights and recommendations.

Qualifications

• Hands-on experience, execution ability, and proven performance take precedence over formal degrees or credentials.
• Core Industry Experience: 8+ years in healthcare economics, managed care finance, or healthcare data analytics with 3–5 years on Commercial lines.
• Applied Reimbursement Expertise: Deep knowledge of Commercial reimbursement methodologies (FFS, DRG/APC, revenue codes, ASC, stop-loss, risk adjustment).
• End-to-End Contract-to-Claims Execution: Evaluate provider contract language, model reimbursement shifts, guide IT/claims configuration for accurate adjudication.
• Technical & Analytical Proficiency: Query, manipulate, and analyze large healthcare claims data with SQL, Python, R, SAS, or cloud warehouses.
• Cross-Functional Leadership: Lead initiatives across Network, Claims, Operations, Engineering, Finance, and Actuarial.
• Strategic Communication: Present complex claims/financial data in plain language to executives.

Responsibilities

• Design, model, and evaluate provider reimbursement structures across Commercial networks (FFS, DRG/APC, bundled payments, risk agreements).
• Conduct pre-contract modeling and scenario analysis for fee schedules and APMS.
• Oversee financial mechanics for value-based contracts, shared savings, and provider incentives.
• Translate contract terms and payment logic into actionable technical specifications with IT teams.
• Establish testing, audit, and validation frameworks to ensure claims honor contracted terms.
• Identify leakage, defects, and remediation opportunities in adjudication systems.
• Decompose Total Medical Expense by price, utilization, mix, and intensity across care settings.
• Synthesize data into executive BI insights and cost-optimization initiatives.
• Benchmark against Medicare/regional data to identify gaps and opportunities.

Skills

Healthcare economics

Managed care finance

Data analytics

Commercial reimbursement

Contract-to-Claims

Data querying

Cross-functional leadership

Executive communication

Value-based care

Tools

SQL

Python

R

SAS

Job description

Devoted Health seeks a Medical Economist to lead strategic contracting and reimbursement design across Commercial networks in the United States. You will model financial impacts, oversee complex provider agreements, and partner with IT and Claims teams to ensure accurate adjudication and cost optimization.

You will drive analytics on Total Medical Expense trends, price, utilization, and mix, delivering executive-ready insights and recommendations.