Subject Matter Expert - Senior Healthcare Pricing SME

This position is listed on behalf of a partner company, who manages all applications and next steps. Our partner is looking for a Subject Matter Expert - Senior Healthcare Pricing SME based in United States.

This fully remote role offers an opportunity to apply deep healthcare pricing expertise to a major federal procurement initiative valued at nearly $1 trillion.

You will lead sophisticated financial and pricing analyses across managed healthcare proposals, helping evaluate commercial assumptions and financial risk.

The role combines healthcare economics, financial modeling, proposal evaluation, and strategic negotiation support.

You will translate complex pricing data into clear, defensible recommendations that inform high-stakes procurement decisions.

Working with multidisciplinary stakeholders, you will assess proposals, identify inconsistencies, and develop evidence-based negotiation positions.

The environment is fast-paced and analytical, requiring exceptional attention to detail, sound judgment, and the ability to work with procurement-sensitive information.

This is a high-visibility opportunity to contribute directly to the financial stewardship of a large-scale federal healthcare program.

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.