Lead, Provider Reimbursement

Position Summary

The Lead of Provider Reimbursement will be responsible for leading a team of analysts in evaluating and optimizing our dental network performance. This role involves developing and implementing analytical strategies, overseeing data analysis projects, and providing actionable insights to enhance network efficiency and member satisfaction. The ideal candidate will have over 6 years of experience in analytics with a strong background in leadership and a deep understanding of dental networks and provider compensation strategy.

You are:

A leader with strong actuarial background and passionate about leveraging data to drive decision-making and improve provider network performance.

You have:

• Candidate is pursuing the Actuarial Associate designation in the Society of Actuaries and intends to pursue the Actuarial Fellow designation; ASA or near-ASA Preferred
• A Bachelor’s Degree in Math, Statistics, Actuarial Science, or related field
• A minimum of 6 years of work experience in the Actuarial field
• Proficiency in Excel and VBA. Other programming knowledge is a plus
• Ability to manage and lead multiple projects and manage 4 or more direct reports 
• Strong analytical and communication skills
• Experience in using Tableau and Alteryx software preferred
• Experience with provider fee analysis (PPO and HMO) preferred

You will:

• Lead and mentor a team of analysts, fostering a collaborative and high-performance work environment.
• Design and execute complex data analysis projects to assess network performance, identify trends, and generate insights.
• Create and present comprehensive reports and dashboards for senior management, highlighting key metrics and actionable recommendations.
• Utilize advanced analytical tools and techniques to drive data-driven decision-making and strategic planning.
• Collaborate with cross-functional teams to identify opportunities for network improvement and cost reduction.
• Develop models and simulations to forecast network performance and evaluate potential changes.
• Monitor and assess the financial impact of network changes.
• Contribute to the development of strategic initiatives and goals for the dental network.
• Provide expert advice and insights to support network expansion, provider relations, and quality improvement efforts.
• Build and maintain strong relationships with internal and external stakeholders, including dental providers and network partners.

Reporting Relationships:

You will report to the Head of Dental and Vision Pricing.

Location:

Preferred locations include New York, NY and Bethlehem, PA. The work arrangement will be hybrid (partial work in a local Guardian Office; partial work from home).

Travel:

Minimal travel may be required for this role.

Salary Range$121,680.00 - $199,905.00

The salary range reflected above is a good faith estimate of base pay for the primary location of the position. The salary for this position ultimately will be determined based on the education, experience, knowledge, and abilities of the successful candidate. In addition to salary, this role may also be eligible for annual, sales, or other incentive compensation.

Our Promise

At Guardian, you’ll have the support and flexibility to achieve your professional and personal goals. Through skill-building, leadership development and philanthropic opportunities, we provide opportunities to build communities and grow your career, surrounded by diverse colleagues with high ethical standards.

Inspire Well-Being

As part of Guardian’s Purpose – to inspire well-being – we are committed to offering contemporary, supportive, flexible, and inclusive benefits and resources to our colleagues.

Health Care

• Choice of [high deductible/copay] medical plans* with prescription drugs, including coverage for fertility and transgender inclusive benefits

• Dental plan

• Vision plan

• Health care accounts – flexible spending, health reimbursement, and health savings accounts

• Critical illness insurance

Life and Disability Insurance

• Company-paid Life and Disability insurance plus voluntary supplemental coverage

• Accident insurance

Retirement and Financial

• 401(k) retirement plan with a company match, plus an annual age/service-based Company contribution and an annual profit-sharing contribution, if applicable

• Complimentary 1:1 financial guidance with a licensed Fidelity representative

Time Off and Remote Work

• Flexible work arrangements (part in-person/part remote)

• Unlimited paid time off for most roles plus time off for volunteering, jury duty, voting, and bereavement

• Personal holidays for colleagues to use in recognition of religious, cultural, or civic days

• Paid parental leave and paid family and medical leave policies

Emotional Well-being and Work-Life

• Emotional well-being, mental health, and work/life resources powered by Spring Health

• Wellness programs, including fitness program and equipment reimbursement

• Child, adult, and elder back-up care support through Bright Horizons

• Adoption assistance

• College planning

• Tuition reimbursement

• Student loan assistance

• Commuter benefits in select metropolitan areas

Equity & Inclusion

Opportunities to build inclusive and meaningful connections through involvement in colleague-led affinity groups:

• Employee Resource Groups:

• Colleague Connection Committees

• Community Involvement Committees

A culture that encourages colleagues to bring their authentic selves to work

• Voluntary self-ID

• Pronunciation and phonetic spelling of names

Benefits apply to full-time eligible employees. Interns are not eligible for most Company benefits.Equal Employment Opportunity

Guardian is an equal opportunity employer. All qualified applicants will be considered for employment without regard to age, race, color, creed, religion, sex, affectional or sexual orientation, national origin, ancestry, marital status, disability, military or veteran status, or any other classification protected by applicable law.

Accommodations

Guardian is committed to providing access, equal opportunity and reasonable accommodation for individuals with disabilities in employment, its services, programs, and activities. Guardian also provides reasonable accommodations to qualified job applicants (and employees) to accommodate the individual's known limitations related to pregnancy, childbirth, or related medical conditions, unless doing so would create an undue hardship. If reasonable accommodation is needed to participate in the job application or interview process, to perform essential job functions, and/or to receive other benefits and privileges of employment, please contact [email protected].

Current Guardian Colleagues: Please apply through the internal Jobs Hub in Workday.