Medical Economics Leader

Complete Health is a value-based care focused healthcare organization that partners with physicians and health plans to improve outcomes, enhance quality performance, and manage total cost of care across Medicare populations. The organization utilizes population health strategies, risk adjustment, care management, and data-driven analytics to support providers in delivering high-quality, value-based healthcare. Given its focus on Medicare Advantage and risk-bearing arrangements, Medical Economics plays a critical role in evaluating financial performance, managing medical costs, forecasting risk adjustment revenue, and supporting strategic growth initiatives.

Director, Medical Economics

Location: Jacksonville, FL (Hybrid)

About the Role

Complete Health is seeking a Director of Medical Economics to lead financial and analytical initiatives supporting its expanding value-based care operations. This individual will be responsible for overseeing medical cost forecasting, reserving, risk adjustment analytics, and healthcare economics across Medicare Advantage and value-based care programs.

This is a highly visible leadership role that will partner closely with Actuarial, Finance, Risk Adjustment, Population Health, and Executive Leadership teams to provide actionable insights that drive clinical and financial performance. The ideal candidate possesses a strong actuarial foundation, holds an ASA designation, and brings deep expertise in medical economics, RAF accruals, IBNR methodologies, and healthcare cost trend analysis.

Key Responsibilities

• Lead development and oversight of monthly Value-Based Care reserving, forecasting, and budgeting processes.
• Own methodologies and reporting associated with IBNR reserves and RAF accruals.
• Utilize CMS SAS software to support risk adjustment analytics and RAF forecasting.
• Track, analyze, and project medical expense and utilization trends, identifying opportunities and risks across the business.
• Develop forecasts and financial models supporting Medicare Advantage and value-based care performance.
• Partner with Finance and Actuarial teams on monthly close processes, budgeting, and long-range financial planning.
• Build and maintain scalable analytical solutions utilizing SQL and large healthcare datasets.
• Perform deep-dive analyses on medical cost, utilization, provider performance, and value-based contract outcomes.
• Present findings and strategic recommendations to executive leadership.
• Lead, mentor, and develop high-performing analytics and medical economics team members.

Required Qualifications

• ASA designation required.
• Bachelor's degree in Actuarial Science, Mathematics, Statistics, Economics, Finance, or related quantitative discipline.
• 8+ years of experience within Medical Economics, Actuarial, Healthcare Analytics, Medicare Advantage, or Risk Adjustment.
• Demonstrated expertise with:
• RAF Accruals
• IBNR Methodologies
• Medical Cost Forecasting
• Budgeting & Financial Planning
• Value-Based Care Analytics
• Healthcare Economics
• Strong proficiency with SQL and healthcare data analysis.
• Proven ability to communicate complex analytical findings to executive stakeholders.
• Prior experience leading teams and cross-functional initiatives.

Preferred Qualifications

• Medicare Advantage experience.
• Experience supporting risk-bearing provider organizations, ACOs, or value-based care entities.
• Experience with Power BI, Tableau, or similar visualization tools.
• Background in risk adjustment, population health, or provider economics.