Medical Economist

Job Description A bit about this role: The Medical Economist is a strategic and operational leader responsible for optimizing medical cost management, driving total cost of care (TCOC) strategy, and maximizing financial performance across Commercial lines of business. This role bridges high-level financial strategy and end-to-end operational execution by evaluating complex provider contract reimbursement models, partnering with technical and claims engineering teams to ensure accurate system configuration and adjudication, monitoring total medical expense (TME) trends, and delivering actionable intelligence to executive leadership. We place the highest value on proven real-world experience, problem-solving ability, and operational impact. While formal education and certifications are recognized, a strong track record of navigating complex Commercial healthcare economics, contract mechanics, and data-driven execution is what truly defines success in this role. Your Responsibilities and Impact will include: Strategic Contracting & Reimbursement Architecture Reimbursement Strategy & Design: Partner with Network Development and Contracting teams to design, model, and evaluate complex provider reimbursement structures across Commercial networks (e.g., FFS, DRG/APC, Ambulatory Payment Classifications, bundled payments, sub-capitation, and value-based risk agreements). Contract Evaluation & Financial Modeling: Conduct rigorous pre-contract modeling and scenario analysis