Medical Economist (Healthcare Economics)

Location: Remote USA

Salary: $175,000–$250,000 per year

Company

hirify.global operates an integrated care platform combining data, AI, clinical, and service experiences to improve the health and well-being of older Americans.

What you will do

• Design, model, and evaluate provider reimbursement structures across Commercial networks, including fee-for-service, DRG/APC, bundled payments, sub-capitation, and value-based risk agreements.
• Conduct contract evaluation, fee-schedule modeling, scenario analysis, and financial assessment of Commercial value-based arrangements, shared savings, risk agreements, and incentive programs.
• Translate contract terms, fee schedules, and payment logic into technical specifications with Claims, Health Plan Operations, Engineering, and IT teams.
• Establish testing, auditing, and validation frameworks for claims adjudication; identify configuration defects, payment leakage, and root causes and drive remediation.
• Analyze Total Medical Expense trends, unit cost, utilization, mix, intensity, high-cost claims, risk adjustment, stop-loss, reinsurance, benefit design, and out-of-network leakage.
• Partner with Actuarial, Finance, Underwriting, Clinical Operations, and Medical Management teams and deliver financial trend packages and recommendations to executives.

Requirements

• 8+ years of progressive hands-on experience in healthcare economics, managed care finance, or healthcare data analytics, including 3–5 years focused on Commercial lines of business such as Individual/ACA, Group, or ASO/Self-Funded.
• Deep practical knowledge of Commercial reimbursement methodologies, including Commercial fee-for-service schedules, Medicare-relative pricing, DRGs, CPT/HCPCS, Revenue Codes, APCs, ASC fee schedules, stop-loss, and Commercial risk adjustment.
• Demonstrated experience evaluating provider contract language, modeling reimbursement changes, and collaborating with IT and claims teams on configuration and accurate claim adjudication.
• Hands-on ability to query, manipulate, and analyze large healthcare claims datasets using SQL, Python, R, SAS, or modern cloud data warehouses.
• Proven ability to lead cross-functional initiatives across Network, Claims, Operations, Engineering, Finance, and Actuarial teams.
• Strong ability to synthesize complex claims and financial data into clear insights and present actionable recommendations to executive leaders.

Nice to have

• Experience designing, evaluating, or managing Commercial ACO models, bundled payments, and shared risk or savings arrangements.
• Practical understanding of state insurance mandates, ACA guidelines, ERISA, and the No Surprises Act.
• Experience in health plan operations, health systems, or provider organizations handling managed care contracts.
• Actuarial credentials such as ASA/FSA or an advanced degree such as a Master’s or MBA.

Culture & Benefits

• Employer-sponsored health, dental, and vision plans with low or no premium.
• Generous paid time off and a parental leave program.
• $100 monthly mobile or internet stipend.
• Stock options for all employees and bonus eligibility, excluding Director-level and above roles.
• 401(k) program and a commitment to a safe, supportive, diverse, and collaborative workplace.