Sun Life U.S. is one of the largest providers of employee and government benefits, helping approximately 50 million Americans access the care and coverage they need. Through employers, industry partners and government programs, Sun Life U.S. offers a portfolio of benefits and services, including dental, vision, disability, absence management, life, supplemental health, medical stop-loss insurance, and healthcare navigation. We have more than 6,400 employees and associates in our partner dental practices and operate nationwide.
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JOB DESCRIPTION:

Sun Life embraces a hybrid work model that balances in-office collaboration with the flexibility of virtual work. Internal candidates are not required to relocate near an office.
The opportunity: The Director of Healthcare Economics will support the Health & Risk Solutions business via the Actuarial Pricing team. Primary focus will be pricing PPO Networks, PBMs, TPAs, and measurement of health capability vendor offerings within our Stop-Loss product. This role will work with Distribution, Underwriting, and Health Capabilities teams to identify, manage, and capitalize on viable growth opportunities.

How you will contribute:

• Develop and enhance rate study methodologies
• Establish and maintain effective pricing models for evaluating traditional medical networks
• Identify, evaluate, and monitor new medical network structures (ACOs, reference-based pricing, narrow networks)
• Provide ongoing pricing assessments of administrators and PBMs as well as any associated cost containment programs
• Evaluate impact of external vendors on catastrophic claims and develop strategies to reflect impact in stop-loss pricing
• Lead the development of measurement techniques for health capability offerings
• Proactively search for additional information used to enhance pricing models
• Identify and execute corrective actions as needed to manage pricing for networks, TPAs, PBMs, and other vendors
• Partner with Underwriting, Distribution, and Product Management to identify, support, and grow profitable relationships or fix unprofitable relationships
• Act as a subject matter expert related to network offerings, vendor capabilities, and their associated values to both internal and external partners, including serving as relationship manager on key partnerships
• Proactively identify opportunities to share information with business partners through formal training sessions, internal documentation, etc.
• Provide leadership and direction to Healthcare Economics team, develop and monitor performance of others

Please refer the Job description for details