Director, Risk Analytics

This is a fully remote position, open to applicants in United States.

📋 Description

• Lead the Risk Analytics team within the Performance Suite.

• Oversee analytics that support the assessment of financial and quality performance as well as intricate financial reconciliations for risk-based partnerships.

• Collaborate with executives in finance, program innovation, actuarial, and account management.

• Establish strategic methodologies for risk partnerships, value-based care models, and metrics related to financial, quality, and utilization.

• Provide analytical support for discovery and product design.

• Manage analytics capabilities and processes to assess capitated risk partnership performance.

• Create cost and utilization forecasts, financial reconciliations, and insights into factors driving utilization.

• Evaluate cost and utilization trends, estimating Evolent's potential to lower costs and enhance quality.

• Support client budgeting and forecasting while packaging essential performance insights.

• Lead customer engagements and present cost and utilization trends during quarterly performance reviews.

• Conduct statistical analyses, develop analytic models, and generate data reports and dashboards.

• Review and enhance analytical tools and processes in collaboration with analytical, product, and IT leaders.

• Manage, mentor, and coach team members.

• Set goals and objectives, evaluate performance, and ensure accountability among staff.

• Design models to quantify and express value.

• Convey actionable insights to both internal and external executive audiences.

• Extract, manage, and analyze claims and operational data using industry-standard metrics.

⛳️ Requirements

• Bachelor's degree, ideally in a quantitative field or with a healthcare focus.

• Minimum of 5 years of experience in claims-based healthcare analytics.

• In-depth understanding of healthcare claims, including institutional versus professional billing and various sites of care/service.

• Familiarity with healthcare reimbursement models, such as Fee for Service, value-based care strategies, and bundled payments.

• Advanced proficiency in Microsoft Excel.

• Advanced proficiency in SQL or SAS for database/statistical programming.

• Moderate proficiency in Microsoft PowerPoint.

• Knowledge of the health insurance financial business cycle, healthcare quality reporting, and benchmarking.

• Capability to thrive in a fast-paced environment.

• Strong communication skills to engage with diverse stakeholders and bridge business and analytical needs.

• Exceptional analytical skills with proven ability to derive insights from both quantitative and qualitative data.

• Previous experience in people management.

• Ability to work autonomously with minimal supervision.

• Submission of a government-issued photo ID and identity verification during interviews.

• Completion of a comprehensive background check.

• In-person I-9 verification required.

• Potential for drug screening prior to employment.

• High-speed internet connection of over 10 Mbps at home.

• Requirement to connect directly to the home internet router for call center employees.

🏝️ Benefits

• Work/life balance.

• Flexible work arrangements.

• Autonomy in work execution.

• Health insurance benefits for eligible employees.

• Comprehensive benefits package.

• High-speed home internet requirement/support context (over 10 Mbps).