Subject Matter Expert - Senior Healthcare Pricing SME

Accountabilities • Lead financial and price analysis of complex managed healthcare proposals associated with a federal procurement valued at nearly $1 trillion.

• Review solicitation requirements, evaluation criteria, contract terms, amendments, and applicable government guidance to assess proposal compliance.

• Crosswalk offeror pricing submissions against required contract structures, line items, periods, regions, benefit categories, and supporting documentation.

• Analyze healthcare pricing components including provider reimbursement rates, unit prices, administrative fees, discounts, reimbursement methodologies, escalation factors, utilization assumptions, staffing costs, and other key cost drivers.

• Validate pricing workbooks by reviewing formulas, calculations, reconciliations, cross-references, assumptions, and supporting documentation.

• Normalize and compare competing proposals using independent estimates, historical results, market benchmarks, government data, and information from other offerors.

• Identify deficiencies, outliers, unsupported assumptions, inconsistencies, ambiguities, unbalanced pricing, and potential financial or performance risks.

• Develop clarification questions and evidence-based negotiation recommendations, including proposed positions and potential financial impacts.

• Prepare detailed Price Analysis Reports, executive briefings, comparison tables, decision-support materials, and traceable source-selection workpapers.

• Incorporate actuarial findings and other relevant analytical inputs into pricing assessments as appropriate.

• Update analyses throughout clarifications, proposal revisions, negotiations, and changes in government direction while maintaining procurement-sensitive information.

• Deliver high-quality analytical work within accelerated timelines and support defensible, well-documented procurement decisions.

Requirements

• Bachelor’s degree in Finance, Accounting, Economics, Mathematics, Actuarial Science, Business, Statistics, Healthcare Analytics, or a related analytical discipline.

• At least 8 years of progressively responsible experience in pricing, financial analysis, proposal evaluation, healthcare economics, or a closely related field.

• At least 6 years of experience analyzing managed healthcare pricing, including provider reimbursement, network discounts, claims pricing, administrative fees, utilization, trend assumptions, or risk-sharing arrangements.

• At least 6 years of experience evaluating complex proposals and developing defensible financial conclusions using advanced Excel, financial modeling, reconciliation, and technical writing.

• Strong analytical skills with the ability to evaluate large and complex datasets, identify inconsistencies, and translate findings into clear recommendations.

• Advanced Excel and financial modeling capabilities, with strong attention to formulas, calculations, reconciliations, and data integrity.

• Excellent technical writing and documentation skills, with the ability to produce clear and traceable analytical reports.

• Experience supporting federal proposal evaluations, negotiated acquisitions, and price analysis is highly desirable.

• Knowledge of FAR Part 15, including price analysis, proposal evaluation, clarifications, discussions, final proposal revisions, and negotiation documentation, is preferred.

• Experience preparing price analysis reports, negotiation memoranda, evaluation findings, or similar acquisition documentation is a strong plus.

• Experience with large-scale government healthcare programs, health-plan procurements, managed-care contracts, or provider networks, including Medicare, Medicaid, TRICARE, VA Community Care, or FEHB, is preferred.

• Familiarity with healthcare claims, encounter, eligibility, provider, utilization, and reimbursement data is advantageous.

• Experience with analytical technologies such as Power Query, Power BI, SQL, Python, or R is a plus.

• Relevant professional certifications such as CPCM, CFCM, CCEA, CPA, CMA, CFA, or a comparable credential are desirable.

• Strong judgment, attention to detail, communication skills, and the ability to work independently in a highly analytical environment.

• Must be authorized to work full-time in the United States and able to obtain a Public Trust Security Clearance.

Benefits

• Competitive salary range of  $100,000–$150,000 USD , with individual compensation determined by factors such as education, experience, skills, and geographic location.

• 100% remote  work arrangement within the United States.

• Comprehensive Total Rewards package.

• Medical benefits, including dental and vision coverage.

• 401(k) contribution plan.

• Holiday and personal paid time off.

• Professional development, training, and certification support.

• Health and wellness subsidies.

• Paid time off for community service.

• Equal employment opportunity and a professional, respectful, and inclusive work environment.

• Reasonable accommodations available where feasible to support individuals in performing essential job functions.

• Employment eligibility verification through the federal E-Verify program.

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