TurningPoint Healthcare Solutions is a leader in advanced clinical and technology-enabled complex condition management. TurningPoint provides an innovative suite of specialty care management services and technologies that enable health plans and employers to improve the safety, quality, and affordability of healthcare. Through its platform and specialized team of clinical experts, TurningPoint works collaboratively with providers to deliver optimal care. TurningPoint offers condition-specific, quality-driven, value-based care management services that optimize care from diagnosis and discovery through recovery. TurningPoint’s comprehensive and integrated suite of services enhances the support individuals need, at the time they need it most. Since launching in 2015, TurningPoint has provided support to more than 50 million people nationwide across numerous clinical specialties including musculoskeletal, pain management, cardiology, wound care, ear/nose/throat, and sleep. TurningPoint’s model moves beyond denial-based care to holistic condition management that improves outcomes and reduces cost. TurningPoint is an independent organization, not owned or affiliated with a health plan or provider system.

Position Summary and Responsibilities:

• Develop a comprehensive pricing and underwriting strategy, including establishment of pricing governance processes and controls, as well as sales support including direct interaction with clients in the form of written and verbal presentations of proposals, assistance with contract negotiations, etc.
• Apply actuarial techniques and statistical analysis across several functions, including claim trend analysis, experience studies, medical economics, profitability analysis, risk adjustment, predictive modeling, and/or claim reserving.
• Support ongoing financial reconciliation processes for value-based care contracts, including eligibility, revenue, and claims reconciliation as well as ad hoc financial operations reporting, provider network analysis, and fee schedule pricing
• Independently initiate and lead the development of complex actuarial studies, analyses, and presentation materials needed to appropriately inform decision makers. Make appropriate recommendations to senior management across teams both within the finance department and across other departments to optimize value-based contract performance
• Design, build, and manage risk adjustment models, leveraging public methodologies (e.g., Medicaid, Medicare, Marketplace) as well as proprietary approaches. Ensure model accuracy through calibration, validation, and continuous performance monitoring, and translate outputs into actionable insights for pricing and value-based care strategy.
• Actively participate in senior leadership meetings, preparing and presenting relevant documents, reports and plans in a timely manner
• Assist senior leadership in financial models and analysis to support strategic partnerships and initiatives
• Process improvements within areas of oversight. Develops and implements plans/projects to improve operational efficiency and effectiveness.
• Hiring and development of staff and succession planning. Communicates goals, objectives, accountabilities, priorities, and authority parameters to assigned staff. Develops leaders through mentoring and coaching of direct reports.
• Building and managing a strong actuarial team is a must, including inspiring, leading, mentoring, measuring and appraising the actuarial team to ensure stellar capabilities at all levels as well as driving a culture of financial accuracy and accountability