Government Programs Performance Consultant

Position Description

Base pay is influenced by several factors including a candidate’s qualifications, relevant experience, and anticipated contributions to meet the needs of the business, along with internal pay equity and external market driven rates. The salary range displayed has not been adjusted for geographical location. This range has been created in good faith based on information known to Capital Blue Cross at the time of posting and may be modified in the future. Capital Blue Cross offers a comprehensive benefits packaging including Medical, Dental & Vision coverage, a Retirement Plan, generous time off including Paid Time Off, Holidays, and Volunteer time off, an Incentive Plan, Tuition Reimbursement, and more. 

At Capital Blue Cross, we promise to go the extra mile for our team and our community. This promise is at the heart of our culture, and it’s why our employees consistently vote us one of the “Best Places to Work in PA.”

This high-impact role supports the financial performance and strategic business insights for our Medicare Advantage, ACA, and CHIP lines of business. Responsible for providing data-driven insights, financial planning, performance optimization strategies, and regulatory alignment to senior leadership.

Responsibilities and Qualifications

• Support financial strategy, forecasting, and performance oversight for Medicare Advantage and ACA portfolios.
• Support financial planning cycles, including annual operating plans, forecasts, and long-range strategic planning for government programs.
• Analyze medical cost trends, revenue drivers, and margin performance to inform executive decision-making.
• Act as a thought leader and financial advisor to internal department stakeholders.
• Direct the development of performance dashboards and executive scorecards for continuous monitoring and accountability.
• Support CMS and state regulatory filings.
• Serve as a subject matter expert on market dynamics and payer economics.

Skills:

• Exceptional strategic and analytical thinking with demonstrated ability to connect data and financial insights to enterprise-level strategy.
• Expert financial modeling and forecasting capability; strong grasp of healthcare cost and revenue drivers. Excellent executive communication skills.
• Proven ability to drive complex initiatives in a matrixed organization.
• High proficiency in financial and data tools such as Excel, SQL, Power BI/Tableau, and statistical modeling platforms
• Strong leadership skills.
• Proven ability to translate complex analytics into strategic action.

Knowledge:

• Deep knowledge of Medicare Advantage and ACA regulations, bid and rating structures, payment methodologies, risk adjustment, STARS, and medical loss ratio (MLR) requirements.
• Strong understanding of CMS guidelines.
• Familiarity with clinical/utilization management and network strategies.

Experience:

• 8 years of progressive experience in healthcare, financial management or related roles.
• Prior experience in a payer or consulting environment is strongly preferred.

Education and Certifications:

• Bachelor’s degree in finance, Actuarial Science, Economics, Health Administration, or related discipline required.
• Advanced degree (MBA, MPH) or professional certification (FSA, ASA, CPA, CFA) strongly preferred.

Physical Demands:

• While performing the duties of the job, the employee is frequently required to sit, use hands and fingers, talk, hear, and see. The employee must occasionally lift and/or move up to 5 pounds.

About Us

We recognize that work is a part of life, not separate from it, and foster a flexible environment where your health and wellbeing are prioritized. At Capital you will work alongside a caring team of supportive colleagues, and be encouraged to volunteer in your community.  We value your professional and personal growth by investing heavily in training and continuing education, so you have the tools to do your best as you develop your career.     And by doing your best, you’ll help us live our mission of improving the health and well-being of our members and the communities in which they live.