Value-Based Expert

Responsibilities: Deliver advanced reimbursement, financial impact, and performance analyses to support managed care negotiations and payer strategy. Design and evaluate value-based payment models, including shared savings, quality measures, risk corridors, and attribution methodologies. Develop pro forma models and conduct sensitivity and stress testing to assess the financial impact of contract changes, cost initiatives, and market trends. Monitor contract and value-based program performance, identifying underpayments, compliance issues, adverse payment trends, and financial risk. Produce monthly forecasts and financial reports covering value-based performance, reconciliation, and variance analysis. Lead quarterly and annual reconciliation audits to ensure payer compliance and identify contract performance gaps. Create scalable tools, analytics, and executive-level visualizations to forecast value-based performance and support enterprise decision-making. Mentor managed care analysts and contribute to analytical standards and process improvements Qualifications: 5-7+ years of progressive experience in healthcare finance, payer analytics, medical economics, or related healthcare consulting (required) Demonstrated experience supporting value-based contract development, including performance measurement, attribution/quality metrics, reconciliation, and dispute resolution/appeals processes (required) Experience with forecasting, audit, and predictive analytics. to support negotiation and contract performance management (required) Advanced proficiency in SQL, Tableau, and/or Power BI. Demonstrated experience extracting, validating, and analyzing large healthcare claims, reimbursement, and/or value-based performance datasets (required) Demonstrable track record of building analytics that drive business decisions and actions. Strong communication skills with the ability to translate complex data into strategic insights for both technical and non-technical audiences (required) Familiarity with actuarial concepts such as IBNR and financial reporting under shared-savings or risk-based arrangements. Deep understanding of CMS programs (Medicare Advantage, Medicaid) and HCC risk adjustment methodologies. (preferred)  Shift: Night Shift Location: BGC, Taguig Arrangement: Hybrid (3 days RTO & 2 days WFH per week)