Director of Medical Economics and Actuarial

Who is Gather Health? 

We are a new and growing value-based care healthcare organization with a unique and innovative approach to healthcare.  Our mission is to improve lives and communities through socially supported primary care for older adults. Our innovative business model allows our clinicians to treat the whole patient - not just their clinical needs. We do this by having a dedicated care team that supports our clinicians by addressing our patients’ social determinants of health and providing the highest quality of service possible.  Our ultimate vision is creating generational health and equity for communities across the country, one patient at a time. 

• Design, refine, and manage reserve and IBNR models to support financial close processes and analytical insights
• Build medical expense projection models to inform budgets and forecasts
• Leverage deep understanding of RAF, HCC, Medicare Advantage bid development, and Medicaid rate-setting methodologies to enhance accuracy of revenue forecasting
• Investigate and track key healthcare cost drivers by segment and/or provider, including trends in utilization, referral behavior, and payment rates
• Research topics in care delivery, evaluate complex datasets, and propose recommendations grounded in claims data, healthcare knowledge, and strategic analysis
• Shape the direction and metrics of success for Gather Health’s actuarial function, ensuring alignment with broader business goals
• Examine claims, enrollment, and prior authorization data for patterns signaling cost or quality challenges
• Deliver actuarial insights by identifying trends and profitability factors using sound statistical methodologies
• Communicate analytical findings clearly and visually to enable informed decision-making
• Collaborate with data / analytics teams in addition to third party actuarial partners to source and validate data, create reports, and apply analytics to solve operational challenges
• Partner across departments to ensure strategic alignment in identifying and managing the most impactful areas of medical expense
• Inform contract negotiations and guide investment decisions using insights driven by medical expense return on investment
• Contribute to special projects and continue growing professional knowledge and skills

• Bachelor's degree in Applied Mathematics, Statistics, Actuarial Science, Economics, or a related discipline
• Associate of the Society of Actuaries (ASA) designation required
• Strong background in Medicare Advantage bids and CMS HCC modeling
• Advanced Excel skills, including use of formulas, PivotTables, Power BI, charts, and reporting tools
• Experience working across functions, including collaboration with IT teams to obtain and structure relevant data
• Demonstrated proficiency in SQL and comfort working with large datasets and relational databases
• Skilled in performing statistically sound product trend analyses

• You excel at self-directed research and problem solving, and enjoy sharing well-developed solutions
• You navigate complex analyses independently or collaboratively, providing insight that drives strategic and financial decisions
• You think several steps ahead, considering potential stakeholder questions before they arise
• You are proactive in using data to find opportunities for performance improvement
• You build strong, trusted relationships with senior internal stakeholders

• We are a mission-based organization that is passionate about changing the way seniors experience primary care 
• Our business model is unique and on the cutting-edge of the primary care industry 
• Our leadership team is comprised of experienced individuals who are committed to creating not only the best patient experience, but also an amazing employee experience for our colleagues 
• We are intentionally building a strong company culture and providing a compassionate and joyful work environment  
• The organization was conceptualized, founded, and launched by experienced co-founders with a track record of success in the healthcare space  

• Market-based base salaries  
• Unlimited/Self-Managed PTO
• 11 Paid Holidays 
• Medical insurance coverage (health, dental, vision) with no waiting period for enrollment  
• Short and Long-Term disability insurance at no cost to you 
• Basic life insurance coverage at no cost to you  
• 401K with $1 for $1 match up to 4% of income 
• Employee Assistance Program at no cost to you  
• Supplemental benefits available for discounted prices

Gather Health is an Equal Opportunity Employer.  All employment decisions are made without regard to age, race, creed, color, religion, sex, national origin, ancestry, disability status, veteran status, sexual orientation, gender identity or expression, genetic information, marital status, citizenship status, or any other basis as protected by federal, state, or local law.