Sr. Manager, APM Modeling & Analytics

Arcadia is dedicated to happier, healthier days for all. We believe that there is a better healthcare world – one powered by data. Our platform transforms complex, diverse data into a unified foundation for health, helping organizations deliver better care, boost revenue, and lower costs. We’re a team of fiercely driven individuals committed to making healthcare more sustainable—and we’re looking for passionate people to help us get there. For more information, visit arcadia.ioWhy This Role Is Important to ArcadiaArcadia is expanding its leadership in advanced alternative payment models (APMs), including CMS’ newly announced LEAD Model and other value-based initiatives. This role will report directly to the Chief Actuary, and serve as the enterprise owner of APM solutions, ensuring technical rigor and financial accuracy across our most strategic engagements.You will not simply advise on strategy — you will own the math.This includes full accountability for:CMS APM (e.g., LEAD, TEAM, ACCESS, MSSP) solution development and implementationCMS data (e.g., VRDC, CCLF, BCDA) ingestion and executionIndependent validation and quality controlsThis role requires deep understanding of CMS and other VBC models, expertise working with CMS data (e.g., VRDC, CCLF, BCDA), strong coding skills (e.g., SAS, Python, SQL), exceptional attention to detail in building and validating complex financial models at scale, and leadership in establishing and enforcing validation and quality assurance controls.What Success Looks LikeIn 3 monthsDevelop deep working knowledge of CMS LEAD model methodology and financial mechanicsContribute to Arcadia’s market communications on the CMS LEAD model (e.g., whitepaper, customer discussions)Gain hands-on access to VRDC data sources and Arcadia’s data ingestion processesUnderstand existing Arcadia APM calculation logic and identify improvement opportunitiesEstablish coding standards and validation protocols for actuarial model governanceIn 6 monthsDevelop CMS LEAD model financial calculations and underwriting framework in collaboration with actuariesFully own other existing Arcadia CMS APM solutions (e.g., MSSP)Serve as the internal subject matter expert for CMS APM financial modelingBuild reproducible, well-documented SAS and Python pipelines for:Customer data ingestionBenchmark constructionRisk score development and normalizationTrend and PMPM projectionsSavings/loss simulationsImplement multi-layer QA processes and reconciliation proceduresIn 12 monthsDeliver production-ready, validated CMS LEAD model outputs to clientsBe recognized as Arcadia’s enterprise leader for APM financial modelingEstablish formal governance for underwriting assumptions and change controlDrive measurable financial accuracy and performance improvement across engagementsInfluence product roadmap to ensure actuarial precision is embedded in platform designWhat You'll Be DoingAPM Model OwnershipOwn end-to-end financial modeling for CMS LEAD and other APMsTranslate CMS technical specifications into production-grade actuarial modelsDevelop and maintain benchmark, attribution, risk adjustment, and reconciliation logicEnsure integrity of actuarial inputs (e.g., underwriting methodology, pricing assumptions) in value-based contract modelingIdentify model vulnerabilities and proactively mitigate financial exposureCMS VRDC & Other Data Technical ExecutionWork directly with CMS VRDC data environments to extract, structure, and analyze Medicare claims and enrollment dataWrite production-level SAS and Python code to:Process large claims datasetsFacilitate risk-adjustmentsCalculate, risk adjust, and project PMPM benchmarksRun sensitivity testingConduct reconciliation and true-up calculationsEnsure compliance with CMS methodological guidanceValidate data integrity prior to model productionQuality & Validation LeadershipEstablish independent validation standards and ensure consistent adherence to these standards across the enterpriseCreate automated testing scripts and exception reporting to implement validation checks, parallel runs, and reconciliation frameworksMaintain version control, documentation, and auditability of all models at a sufficiently robust level to enable audits or CMS reviewWhat You'll BringBachelor's Degree in related Data Science, Actuarial Science, Finance, Economics or related fieldMinimum of 6 years of healthcare experience, with a focus on CMS APMs, value-based contracting and analyticsStrong accountability, intellectual curiosity, and customer satisfaction mindsetExperience modeling and evaluating key financial parameters within value-based contracts for health plan or providerExperience with database querying (SAS, SQL, Python), Amazon Quick Site or BI Tool equivalentWould Love For You To HaveActuarial experience or experience supporting actuaries with CMS/CMMI Models (LEAD, TEAM, ACCESS, MSSP, etc.)Consulting experience with deadline-driven project management accountability and effective communication of c