Subject Matter Expert - Senior Healthcare Pricing SME

Job Location: 

This role is 100% remote.

Clearance:

Must be currently authorized to work in the United States on a full-time basis and have the ability to obtain a Public Trust Security Clearance. 

Job Description:

Blake Willson Group is seeking a Senior Healthcare Pricing Subject Matter Expert (SME) to lead the financial and price analysis of proposals supporting a major federal managed healthcare procurement with an estimated aggregate value approaching $1 trillion. The consultant will independently evaluate proposed pricing, methodologies, assumptions, supporting data, and solicitation compliance and develop clear, defensible findings to support Government evaluation and negotiation activities. The position requires direct experience analyzing managed healthcare pricing, including provider reimbursement, network discounts, administrative fees, utilization, trend assumptions, regional adjustments, risk arrangements, and other healthcare cost drivers. In this position, you will also:

• Lead financial and price analysis of complex managed healthcare proposals valued at nearly $1 trillion.
• Review solicitation requirements, evaluation criteria, contract terms, amendments, and Government guidance to assess proposal compliance.
• Crosswalk Offeror pricing submissions against required structures, contract line items, periods, regions, benefit categories, and supporting data.
• Analyze rates, unit prices, administrative fees, discounts, reimbursement methodologies, escalation factors, trend assumptions, staffing costs, and other key cost drivers.
• Validate pricing workbooks by reviewing formulas, calculations, reconciliations, cross-references, and supporting documentation.
• Normalize and compare competing proposals using independent estimates, historical results, market benchmarks, Government data, and other Offeror submissions.
• Identify deficiencies, outliers, unsupported assumptions, inconsistencies, ambiguities, unbalanced pricing, and potential cost or performance risks.
• Develop clarification questions and evidence-based negotiation recommendations, including proposed positions and potential financial impacts.
• Prepare Price Analysis Reports, executive briefings, comparison tables, decision-support materials, and traceable source-selection workpapers; incorporate actuarial findings as appropriate.
• Update analyses through clarifications, proposal revisions, negotiations, and Government direction while maintaining procurement-sensitive information and meeting accelerated timelines.

Required Skills:

• Bachelor’s degree in Finance, Accounting, Economics, Business, Healthcare Administration, Mathematics, Statistics, or a related discipline.
• 6+ years of experience providing direct support to Federal Contracting Officers, contracting offices, or source-selection teams, including proposal evaluation and price analysis under FAR Part 15, with experience evaluating clarifications, proposal revisions, and Final Proposal Revisions (FPRs).
• 6+ years of experience in Federal healthcare pricing, preferably supporting VA/VHA, CMS, DHA/TRICARE, HHS, or comparable programs, with demonstrated knowledge of managed-care, provider-network, third-party administrator, or large-insurer pricing.
• 6+ years of experience developing Price Analysis Reports, fair-and-reasonable determinations, POM/PNMs, and pre-/post-negotiation memoranda, with the ability to translate complex pricing analyses into clear, defensible findings and recommendations.

Desired Skills:

• Experience supporting Federal proposal evaluations, negotiated acquisitions, clarifications, discussions, and Final Proposal Revisions (FPRs), with knowledge of FAR Part 15 price analysis and acquisition documentation.
• Experience preparing Price Analysis Reports, Price Negotiation Memoranda (PNMs), prenegotiation objectives, evaluation findings, and other negotiation-support documentation.
• Experience supporting large-scale Government healthcare programs, health-plan procurements, managed-care contracts, provider networks, or third-party administrators.
• Federal healthcare experience with VA/VHA, CMS, DHA/TRICARE, HHS, Medicare, Medicaid, VA Community Care, FEHB, or comparable programs.
• Experience evaluating medical and dental claims pricing, utilization, unit costs, provider reimbursement, network pricing, administrative fees, trend and escalation assumptions, and value-based or risk-sharing arrangements.
• Experience working with healthcare claims, encounter, eligibility, provider, utilization, and reimbursement data, with proficiency in Power Query, Power BI, SQL, Python, R, or similar analytical tools.
• Relevant professional certification such as CPCM, CFCM, CCEA, CPA, CMA, CFA, or comparable credential.

At Blake Willson Group, we believe in transparency and fairness in compensation practices. For this position, we offer a competitive salary range of $100,000 to $150,000 in the United States. Your individual salary within this range will be determined by various factors, including but not limited to your education, experience, skills, and geographic location. We also provide a comprehensive Total Rewards package, which includes major medical benefits such as dental and vision coverage, a 401(k)-contribution plan, holiday and personal time off, professional development training & certification benefits, health & wellness subsidies, paid time off for community service, and more. We value your contributions and are committed to recognizing and rewarding your performance and the value you bring to our business.