Value Based Expert

Work Setup: Hybrid – 3x in office

Shift: 8:00 PM – 5:00 AM

Schedule: Monday to Friday

Location: BGC, Taguig, Philippines

KEY RESPONSIBILITIES

• Prepare advanced reimbursement, financial impact, and performance analyses to support managed care contract negotiations and payer strategy.
• Design and evaluate value-based payment models, including shared savings, quality metrics, risk corridors, and attribution methodologies.
• Develop pro forma, sensitivity, and stress-test analyses to assess financial outcomes under different utilization and cost scenarios.
• Monitor contract and value-based program performance, identifying underpayments, compliance gaps, unfavorable payment trends, and financial risks.
• Develop monthly forecasts and financial reports covering value-based performance, payment reconciliation, and variance analysis.
• Conduct quarterly and annual reconciliation audits to ensure payer compliance with contractual terms.
• Develop innovative analytical tools and methodologies to monitor healthcare trends and forecast value-based performance.
• Analyze payer data, market trends, and industry developments to support negotiation strategies and enterprise decision-making.
• Create executive-ready dashboards and visualizations tailored to both clinical and financial stakeholders.
• Build scalable and repeatable analytical processes across value-based programs.
• Mentor Managed Care Analysts and provide technical guidance and support for process improvements.

QUALIFICATIONS:

• Bachelor’s degree in STEM, Economics, Actuarial Science, Health Economics, Business Administration, Finance, Accounting, Healthcare Administration, or a related field. (Master’s degree in MBA, MHA, MPH, Finance, or a related field is preferred)
• 5+ years of progressive experience in healthcare finance, payer analytics, medical economics, healthcare consulting, or a related field.
• Proven experience developing analytics that drive business decisions and measurable actions.
• Experience supporting value-based contract development, including performance measurement, attribution, quality metrics, reconciliation, and dispute resolution/appeals.
• Experience in forecasting, auditing, and predictive analytics for contract performance management.
• Advanced proficiency in SQL, Tableau, and/or Power BI.
• Experience working with large healthcare claims, reimbursement, and/or value-based performance datasets.
• Strong communication skills with the ability to translate complex data into clear, strategic insights for technical and non-technical audiences.

A BIG PLUS IF YOU HAVE:

• CHFP or CPHQ certification.
• Familiarity with actuarial concepts such as IBNR, shared savings, and risk-based financial reporting.
• Knowledge of CMS programs, Medicare Advantage, Medicaid, and HCC risk adjustment methodologies.
• Deep understanding of managed care contracts, reimbursement methodologies, and value-based payment models.

Work Location: Hybrid remote in Taguig