Senior Population Risk Performance Analyst – Value-Based Care

This is a fully remote position, open to applicants in North Carolina.

📋 Description

• Utilize population risk and actuarial models to standardize performance measurement across value-based care initiatives.

• Implement CMS-HCC, Milliman, and other relevant population risk methodologies for the assessment of performance and financial metrics.

• Assist in the creation and upkeep of risk-adjusted total cost of care and quality performance indicators.

• Validate methodologies for performance measurement utilized in shared savings, downside risk, and alternative payment frameworks.

• Examine population risk trends and assess their impact on financial performance and provider outcomes of programs.

• Collaborate with actuarial and finance teams to ensure alignment of modeling assumptions with contractual measurement criteria.

• Detect and analyze performance discrepancies influenced by population acuity, attribution shifts, coding variations, or data completeness.

• Aid in performance year reconciliation, settlement calculations, and financial exposure assessments.

• Define and document measurement methodologies, assumptions, and governance controls for models.

• Work together with analytics and data engineering teams to incorporate risk modeling logic into reporting and measurement processes.

• Offer analytical expertise in support of provider performance evaluations and measurement inquiries.

• Convert complex modeling results into understandable insights for operational and executive stakeholders.

• Ensure consistency and repeatability of population measurement processes across various programs and performance periods.

• Act as a subject matter expert in population risk interpretation to support value-based care strategies and operations.

⛳️ Requirements

• Bachelor's degree or advanced degree in healthcare administration, business, public health, or a related discipline, or 7+ years of relevant experience in place of a degree.

• 5+ years of experience in a related field.

• Proven experience with population risk models, including CMS-HCC and Milliman methodologies (or their equivalents).

• Expertise in analyzing healthcare claims and eligibility datasets.

• Strong proficiency in SQL and analytical data handling.

• Experience in supporting Medicare Advantage and Commercial value-based care initiatives.

• Familiarity with total cost of care measurement and shared savings frameworks.

• Experience working alongside actuarial, finance, or clinical economics teams.

• Knowledge of attribution methodologies and population performance analytics.

• Experience in supporting provider settlement or reconciliation activities.

• Authorization to work in the United States.

🏝️ Benefits

• Annual Incentive Bonus

• 401(k) with employer match

• Paid Time Off (PTO)

• Competitive health benefits

• Wellness programs

• Reasonable accommodations for applicants with disabilities