高级医疗精算顾问
Senior Healthcare Actuarial Consultant
利用技术提升国家福利、国防和安全的财务管理水平
Blake Willson Group (BWG) 将深厚的行业专家与技术人员结合，利用领先的财务管理系统解决最重要的任务目标。公司总部位于国家首都地区，通过以技术为导向的战略和先进解决方案实现可衡量的成果，推动任务成功。
Blake Willson Group 在卓越表现方面有着杰出的记录，实现了运营效率，使客户能够以更少资源做更多事情。BWG 通过始终如一地超越期望，以对最佳价值解决方案的坚定承诺，赢得了客户的信任，并迅速实施。
职位地点：
此职位为100%远程办公。
资质要求：
必须目前有权在美国全职工作，并具备获得公共信任安全许可的能力。
职位描述：
Blake Willson Group 正在寻找一名高级医疗精算顾问，以支持对重大联邦采购的复杂医疗提案进行评估。该顾问将运用在医疗数据、成本和使用模型、报销、定价、风险调整和费率开发方面的实际经验，独立评估提案和支持分析。与高级定价顾问合作，该顾问将把复杂的医疗数据和分析结果转化为清晰的建议，支持提案评估、澄清、谈判和来源选择。理想的候选人应具有近期的医疗建模和数据分析经验，并能够独立评估假设、方法和相关数据。在此职位中，您还将：
- 评估医疗提案的定价、成本模型、费率开发方法、使用情况、报销、趋势、风险调整和支持数据。
- 审查招标要求、评估标准、数据规范、修正案、政府假设和其他采购文件。
- 分析索赔、就诊、资格、会员、供应商、使用情况、报销等医疗数据的质量、完整性和合理性。
- 审查、修改、维护、测试并独立验证医疗分析和定价模型，包括公式、假设、输入、输出和模型逻辑。
查看英文原文
Harnessing Technology to Improve Financial Stewardship for the Welfare, Defense, and Security of Our Nation
Blake Willson Group (BWG) unites deep domain experts with technologists who leverage industry-leading financial management solutions to address the most critical mission objectives. Headquartered in the National Capital Region, the firm delivers measurable outcomes through technology-forward strategies and advanced solutions that drive mission success.
Blake Willson Group has a distinguished track record of exceptional performance, achieving operational efficiencies that allow our clients to do more with less. BWG has earned the confidence of its clients by consistently exceeding expectations through its unwavering commitment to best value solutions, implemented with speed.
Job Location:
This role is 100% remote.
Clearance:
Must be currently authorized to work in the United States on a full-time basis and have the ability to obtain a Public Trust Security Clearance.
Job Description:
Blake Willson Group is seeking a Senior Healthcare Actuarial Consultant to support the evaluation of complex healthcare proposals for a major federal procurement. The consultant will apply hands-on experience with healthcare data, cost and utilization models, reimbursement, pricing, risk adjustment, and rate development to independently evaluate proposals and supporting analyses. Working with a Senior Pricing Consultant, the consultant will translate complex healthcare data and analytical findings into clear recommendations supporting proposal evaluation, clarifications, negotiations, and source selection. The ideal candidate will have recent hands-on healthcare modeling and data analysis experience and the ability to independently assess assumptions, methodologies, and supporting data. In this position, you will also:
- Evaluate healthcare proposal pricing, cost models, rate-development methodologies, utilization, reimbursement, trend, risk adjustment, and supporting data.
- Review solicitation requirements, evaluation criteria, data specifications, amendments, Government assumptions, and other acquisition documentation.
- Analyze claims, encounter, eligibility, membership, provider, utilization, reimbursement, and other healthcare data for quality, completeness, consistency, and reasonableness.
- Review, modify, maintain, test, and independently validate healthcare analytical and pricing models, including formulas, assumptions, inputs, outputs, and model logic.
- Evaluate healthcare cost projections and identify key drivers, anomalies, unsupported assumptions, methodological limitations, data deficiencies, and financial risks.
- Perform calculations, reconciliations, sensitivity analyses, scenario testing, benchmarking, and other analytical procedures to assess proposed results.
- Compare proposal assumptions and results against historical experience, Government assumptions, independent estimates, market data, and other relevant benchmarks.
- Develop clarification questions, written findings, and recommendations addressing data, modeling, methodology, pricing, and potential financial risks.
- Collaborate with the Senior Pricing Consultant and acquisition team to support proposal evaluations, negotiations, source selection, and analysis of proposal revisions and FPRs.
- Maintain traceable workpapers and communicate clear analytical findings to technical, financial, acquisition, and Government stakeholders while protecting sensitive information.
Required Skills:
- Bachelor’s degree in Actuarial Science, Mathematics, Statistics, Economics, Healthcare Analytics, or a related field.
- 7+ years of experience in healthcare actuarial analysis, managed-care analytics, healthcare economics, reimbursement, claims analytics, healthcare pricing, data analytics, or a related field.
- 3+ years of recent hands-on experience developing, maintaining, materially modifying, testing, or independently validating healthcare cost, utilization, reimbursement, pricing, or rate-development models, including direct analysis of underlying healthcare data and assumptions.
Desired Skills:
- Experience evaluating another organization's healthcare pricing, rates, actuarial submissions, reimbursement proposals, analytical models, or underlying assumptions for a purchaser, regulator, health plan, Government agency, or advisory client.
- Experience supporting federal or state healthcare procurements, proposal evaluations, price analysis, clarification development, negotiation support, source selection, or related acquisition activities.
- Experience with Medicare, Medicaid, TRICARE, VA Community Care, FEHB, commercial managed care, or other large-scale healthcare programs, including medical, dental, pharmacy, health-plan, TPA, or provider-network environments.
- Experience analyzing healthcare data, including claims, encounter, eligibility, membership, provider, reimbursement, and utilization data, and performing data validation, reconciliation, trend analysis, benchmarking, sensitivity analysis, or scenario modeling.
- Experience using SQL, SAS, R, Python, Power BI, Power Query, Excel, or other analytical, actuarial, modeling, or business intelligence tools, with the ability to develop clear analytical reports, proposal findings, price analyses, or negotiation-support materials.
- ASA or FSA designation, membership in the American Academy of Actuaries, active progress toward an actuarial credential, or substantial equivalent healthcare actuarial experience, with demonstrated ability to communicate complex analytical findings and deliver accurate, traceable products under compressed procurement timelines.
At Blake Willson Group, we believe in transparency and fairness in compensation practices. For this position, we offer a competitive salary range of $130,000 to $180,000 in the United States. Your individual salary within this range will be determined by various factors, including but not limited to your education, experience, skills, and geographic location. We also provide a comprehensive Total Rewards package, which includes major medical benefits such as dental and vision coverage, a 401(k)-contribution plan, holiday and personal time off, professional development training & certification benefits, health & wellness subsidies, paid time off for community service, and more. We value your contributions and are committed to recognizing and rewarding your performance and the value you bring to our business.
The statements above describe the general nature and level of work anticipated for this role. They are not intended to be an exhaustive list of all duties, responsibilities, or skills required. Blake Willson Group reserves the right to modify, assign, or add job-related responsibilities as business needs require. Where feasible, reasonable accommodations may be provided for individuals to perform essential job functions.
Blake Willson Group is an Equal Employment Opportunity (EEO) employer and is committed to maintaining a professional, respectful, and harassment-free workplace. All employment decisions are based on business needs, qualifications, and merit. We comply with all applicable federal, state, and local employment laws and do not discriminate on the basis of race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, protected veteran status, genetic information, or any other legally protected status. Blake Willson Group prohibits unlawful discrimination, harassment, and retaliation.
Blake Willson Group complies with federal equal employment opportunity requirements. The “Know Your Rights: Workplace Discrimination Is Illegal” poster is available to applicants and employees. View the official poster here: Know Your Rights: Workplace discrimination is illegal
If you require a reasonable accommodation during the application process, please contact us at 202-381-0603, Ext. 3.
Blake Willson Group participates in E-Verify to confirm employment eligibility and will provide the federal government with your Form I-9 information to verify authorization to work in the United States.
Originally posted on Himalayas