Director, Actuarial Provider Network Analysis and Pricing

Judi Health is a health technology company providing benefit administration solutions to employers, unions, health plans, and government entities. Judi Health replaces fragmented, outdated systems with the industry's first Unified Claims Processing™ architecture, seamlessly consolidating pharmacy and medical benefit administration on a single, secure platform. By delivering true price transparency, eliminating unnecessary middleman fees, and leveraging advanced AI-powered care delivery, Judi Health helps clients achieve unprecedented operational efficiency and service levels.

About the role

The Director, Actuarial Provider Network Analysis and Pricing is part of the growing Judi Care Actuarial and Underwriting team, which partners with the network team to ensure contract negotiations, network strategy, and understanding of network performance are informed by reliable data and modeling. This leadership role will engage regularly with network, sales, and underwriting leadership. This is the initial team member focused on provider network analysis and will work alongside Actuarial and Underwriting leadership to build out the team.

Responsibilities

• Network analytics infrastructure: Lead and own the build-out of infrastructure to leverage market and transparency data for contract analysis with an ultimate focus on total cost of care.
• Negotiation strategy support: Coordinate, perform modeling, and present analyses to influence negotiation strategy for contracts including fee-for-service, bundles, and capitation. Consider impact of network composition changes (e.g., removal or addition of network providers with transition to other providers and sites of care).
• Pricing analysis: Lead efforts to price and quantify the impact of provider tiering, episode-level, and other network innovations that drive higher quality and affordability, rolling up to employer group pricing.
• Network strategy analysis: Partner with provider contracting and delivery system teams to develop network strategy and tools to support negotiations.
• Actuarial professional responsibilities: Influence senior business partners by translating complex actuarial constructs into actionable recommendations; initiate actuarial and financial advice in compliance with Actuarial Standards of Practice.
• Actuarial models: Identify needs and provide guidance on building frameworks and assumptions for new, existing, and non-traditional actuarial models to meet business needs.
• Benefit design and pricing: Partner with underwriting to model and price innovative benefit plan designs that leverage network strategy.

Requirements

• Bachelor’s degree in mathematics or related field. Additional equivalent work experience in a directly related field may substitute for the degree requirement.
• Minimum eight (8) years of actuarial experience.
• Associate of the Society of Actuaries (ASA) or Fellow of the Society of Actuaries (FSA).

Preferred Qualifications

• Four (4) years of experience in a leadership role with or without direct reports.
• Five (5) years of experience with provider contracting analysis.
• Programming experience (SQL, SAS, Python, R).

Schedule

Hybrid (3 days per week in NYC, Denver, or Charlotte offices).

Pay

• New York, NY: $187,600 USD - $234,500 USD
• Denver, CO: $172,000 USD - $215,000 USD
• Charlotte, NC: $156,400 USD - $195,500 USD