Actuary Job Description Samples
Results for the star of Actuary
Req ID: 45234BR POSITION SUMMARY This position is responsible for actuarial services in support of our metro St. Louis and Iowa commercial business, including rate filing and other regulatory compliance, pricing, reserving, and forecasting support. The actuarial team works closely with other functional areas, including underwriting, product, sales, finance as well as market leadership. Fundamental Components: Support actuarial functions by applying quantitative skills and analytical methods. Set own priorities within pre-established overall deadlines. Leverage strong technical skills to achieve business solutions and demonstrate understanding of business and product processes. Complete tasks independently with some direction from supervisor. Compile and analyze data and prepare exhibits to support rate filing development and submission. Manage personal resources efficiently to complete projects and exhibit innovative use of resources. Provide input into decision making process. Provide technical support and analysis for planning, forecasting and reporting processes. Demonstrate Microsoft Excel proficiency and familiarity with databases. Exercises decision making within scope of authority. Acts as a mentor to new or less experienced staff. Turns data into information and suggests alternatives or improvements. Demonstrates understanding of intradepartmental products, programs, processes and policies. Works with supervisor to understand nature of specific risks and shares results of analysis with management, including financial impact. Develops creative technical solutions for a variety of problems. Represents area in multi-functional workgroups. Responds to complex inquiries. BACKGROUND/EXPERIENCE desired: Bachelor's degree along w/4 + years experience in an actuarial capacity Associate of the Societies of Actuaries (ASA) is required Strong Excel skills Experience with health insurance pricing and filing, particularly for small group, is preferred. LOCATION: Preferred office locations are Overland Park, KS, Chicago, IL, Walnut Creek, CA, Hartford, CT, Blue Bell, PA, or Bethesda, MD. EDUCATION The highest level of education desired for candidates in this position is a Bachelor's degree or equivalent experience. FUNCTIONAL EXPERIENCES Functional
Actuarial/Pricing: local market & rate filings/4+ Years Functional
Actuarial/Risk analysis/management/4+ Years REQUIRED SKILLS General Business/Communicating for Impact/ADVANCED General Business/Turning Data into Information/ADVANCEDGeneral Business/Talent Development/ DESIRED SKILLS Leadership/Engaging and Developing People/FOUNDATION Technology/Leveraging Technology/ADVANCED ADDITIONAL JOB INFORMATION Aetna is about more than just doing a job. This is our opportunity to re-shape healthcare for America and across the globe.
We are developing solutions to improve the quality and affordability of healthcare. What we do will benefit generations to come. We care about each other, our customers and our communities.
We are inspired to make a difference, and we are committed to integrity and excellence. Together we will empower people to live healthier lives. Aetna is an equal opportunity & affirmative action employer.
All qualified applicants will receive consideration for employment regardless of personal characteristics or status. We take affirmative action to recruit, select and develop women, people of color, veterans and individuals with disabilities. We are a company built on excellence.
We have a culture that values growth, achievement and diversity and a workplace where your voice can be heard. Benefit eligibility may vary by position. Click here to review the benefits associated with this position.
Aetna takes our candidate's data privacy seriously. At no time will any Aetna recruiter or employee request any financial or personal information (Social Security Number, Credit card information for direct deposit, etc.) from you via e-mail. Any requests for information will be discussed prior and will be conducted through a secure website provided by the recruiter.
Should you be asked for such information, please notify us immediately. Job Function: Actuarial
Associate Actuary - US - 132929
/Your Talent. Our Vision./At
Anthem, Inc.,it’s a powerful combination, and the foundation upon which we’re creating greater care for our members, greater value for our customers, and greater health for our communities. Join us and together we willdrive the future of health care.
This is an exceptional opportunity to do innovative work that means more to you and those we serve at one of America's leading health benefits companies and a Fortune Top 50 Company.
Associate Actuary *Location: Any Anthem Office
Associate Actuary*will support Large Group National Accounts. This position will be responsible for ASO pricing strategy and complete the most diverse and complicated projects and perform highly complex actuarial studies. The incumbent will provide client facing consultative analysis with Account Managers, Sales, and other customers. Primary duties may include, but are not limited to:
Performs key actuarial functions including ASO pricing, evaluation of the impact of new legislation, flexible benefit consulting, and special projects.
Designs and completes special projects related to ASO pricing and strategy, other regulation and product development and management.
Responsible for recommendations on pricing, marketing, product design, claims, premium and enrollment administration of ASO Large Group National Accounts.
Requires a BS/BA degree; ASA required from the Society of Actuaries (SOA); at least 4 years related experience; or any combination of education and experience, which would provide an equivalent background.
Experience with health care reform, health insurance product development/maintenance, and/or pricing health care insurance are all preferred skill sets.
Working toward FSA designation is also a strong preference.
Travel required. /Anthem, Inc. is ranked as one of America’s Most Admired Companies among health insurers by Fortune magazine and is a 2016 DiversityInc magazine Top 50 Company for Diversity. To learn more about our company and apply, please visit us at antheminc.com/careers. EOE. M/F/Disability/Veteran./
- Equal Employment Opportunity Statement Anthem, Inc. will recruit, hire, train and promote persons in all job titles without regard to age, color, disability, gender (including gender identity), marital status, national origin, race, religion, sex, sexual orientation, veteran status, or other status protected by applicable law. In addition, all personnel actions such as compensation, promotion, demotion, benefits, transfers, staff reductions, terminations, reinstatement and rehire, company-sponsored training, education and tuition assistance, and social and recreational programs will be administered in accordance with the principles of equal employment opportunity.
Title:Associate Actuary - US - 132929
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Senior Healthcare Actuary
Senior Healthcare Actuary Position Code17-3435 Position ScheduleFull Time Employee LocationElkridge, MD Position Summary
Senior Healthcare Actuary:We’re looking for a quantitatively trained professional, who is naturally curious and innovative. This is an exciting opportunity for the right actuary to stretch beyond the bounds of a typical role and analyze more than just financial/claims data with opportunities to assess health outcomes, quality of care, clinical program effectiveness, and risk adjustment (RAF). The position is responsible for planning, designing, performing pattern analysis and presenting results of health care related information using statistical software and will also serve as a lead or technical resource for other team members.Essential Functions
Senior Healthcare Actuary:Gather, analyze and present data in a format appropriate for loss reserving, product development, and other financial analysis. Make recommendations and present data to appropriate personnel.Design and conduct actuarial analyses that quantify the impact of policy and/or market changes.Apply actuarial concepts and methods to a range of complex health policy and business issues, formulate creative and reusable strategies, multi-task, translate work products into meaningful guidance for clients.Designs optimal methodologies for statistical analyses and reporting including sampling, data collection tool design, validation and reliability methods, experimental design, statistical modeling, data communication and pattern analysis.
Provides recommendations to Company management.Serve as a technical resource to team members as it relates to statistical analysis and methodologies. Provides training and guidance as needed.Interprets and draws conclusions on analysis results. Integrates analysis results into activities and/or projects.
Provides statistical/data analysis education and consultation to project team members. Drafts various types of documentation describing analysis techniques.Creates analysis tools for retrieving information including programming of statistical software programs. Maximizes tools for efficiency in data collection by staying abreast of new technologies.Researches and archives internal and external data sources for use in analysis activities.
Manages and monitors the integrity of data ensuring quality and accuracy. Serves as a technical resource to physicians and Company management regarding the availability and reliability of data sources.Performs miscellaneous duties as assigned. Requirements
Senior Healthcare Actuary:Minimum of 5 years’ actuarial experience.Successful candidates will thrive in a fast-paced environment and have the ability to apply actuarial concepts and formulate solutions to address health policy issues and business needs.Specific background related to government programs (Medicare, Medicaid, CHIP) and/or fully insured markets (individual, small group, large group), as well as experience working on health policy issues.Trained to ascertain risks using analysis of statistical data and the ability to use probability in the forecasting of risk and liability. Masters degree in mathematics or statistics or related field and/or equivalent experience and/or training. 3 - 5 years experience performing statistical analysis or research.2 years experience performing in a leadership role.Additional Comments
Senior Healthcare Actuary:This position is contingent upon award.Professional certification viewed very favorable.Experience with SAS is strongly preferred.Experience working with the United States Navy Bureau of Medicine and Surgery (BUMED) is highly preferred. Work Environment-Senior Healthcare Actuary:Sensitivity level of information handled in this position: moderate.Telligen will not provide sponsorship for this role.Telligen and its affiliates are Affirmative Action, Equal Opportunity Employers (EOE/M/F/Vet/Disability) and E-Verify Participants.
Sr Business Data Analyst, Optumrx Actuary - Cypress, CA, Phoenix, AZ
We'll put you in the driver's seat on vital projects that have strategic importance to our mission of helping people lead healthier lives. Yes, we share a mission that inspires.
We need your organizational talents and business discipline to help fuel ours. It's the opportunity to do your life's best work.(sm) Use your Sharp Analytical Skills to help us support, compile and report key information! Make solid recommendations based on the analysis and provide explanations for reporting results for both internal client management and our E&I book of business.
As a Sr Business Data Analyst at OptumRx, you will grow and develop as you conduct and calculate outcomes of various research and analytic requests. You will be challenged to analyze, research, and interpret data for clients and business planning. As a key resource, you must maintain a high degree of accuracy along with attention to detail, excellent oral and written communication skills, strong personal work ethic and the ability to manage time to meet deadlines.
Success in this role will require ability to prioritize and multitask, as well as being flexible, resourceful, and self-driven! Primary Responsibilities: Support client issue remediation by reviewing and analyzing pharmacy claims (before and after scenarios) Review external auditor findings, for either agreement or disagreement Research, analyze, and evaluate claims data to identify patterns and validate accuracy Work closely with the client account team and other functional departments Provide explanations, interpretations, and recommendations for reporting results as needed Support various projects with financial impacts as needed Core Competencies:
Detail oriented (specifically focused on data accuracy and presentation) Must be able to manage time efficiently and prioritize effectively to adhere to deadlines Ability to multitask in a dynamic setting and work well under pressure Strong organizational skills to track requests and deliverables Must be pro-active and have good problem solving skills Ability to work both independently and within a team setting Ability to learn quickly and desire to take on new challenges Strong desire to make continuous improvements in all areas of responsibility Ability to follow through and be resourceful Ability to develop and interpret requestors criteria and intent, to produce informative and actionable results Self-directed, works with minimal guidance, but recognizes when guidance needed Required Qualifications: Bachelor’s degree or 4 or more years of previous experience within a Report Analyst or Business Analyst role Knowledge of PBM and pharmacy benefit structure Experience in Microsoft Excel: complex conditional formulas, nested formulas, V-lookups, pivot tables Experience in Microsoft Access: create tables, queries, joins, data manipulation Preferred Qualifications: Bachelor’s Degree in Business, Finance, Health Administration Location:
Cypress, CA or Phoenix, AZ Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make health care work better for everyone.
So when it comes to how we use the world's large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter.
Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work.(sm) Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law. UnitedHealth Group is a drug - free workplace.
Candidates are required to pass a drug test before beginning employment. Job Keywords: Sr Business Data Analyst, OptumRx Actuary, Cypress, CA, California, Phoenix, AZ, Arizona 224f8704-6948-435e-b13e-e06349aff51f Sr Business Data Analyst, OptumRx Actuary - Cypress, CA, Phoenix, AZCalifornia-Cypress723417
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Actuary / Model Validation Analyst - Insurance
Founded in 1851, MassMutual is committed to its purpose: We help people secure their future and protect the ones they love. Ranked No. 76 in the annual FORTUNE® 500 ranking (FORTUNE® Magazine, 6/15/16), MassMutual continues its long history of financial strength. We invite you to bring your bright, innovative ideas to MassMutual as we continue to help millions of Americans achieve their financial goals. We continue to be recognized for our efforts to create a diverse and inclusive workplace! MassMutual is one of DiversityInc’s 2016 Top 50 Companies for Diversity and ranked a 2016 Top 10 Company for Executive Women by the National Association for Female Executives. In 2015, after more than 15 years of earning a place on the Working Mother Top 100 Best Companies list, MassMutual was inducted into the Working Mother Hall of Fame. MassMutual also scored 100 percent on The Human Rights Campaign's Corporate Equality Index (CEI) to earn a spot on the CEI Best Places to Work List (2016). In addition, MassMutual has been recognized as a World’s Most Ethical Company by the Ethisphere Institute and 2016 Military Friendly Employer by Military Friendly. For more information, visit www.massmutual.com or find us on Facebook, Twitter, LinkedIn, YouTube, Google+ and Pinterest. MassMutual Financial Group is a marketing name for Massachusetts Mutual Life Insurance Company (MassMutual) and its affiliated companies and sales representatives. CRN201806
POSITION SUMMARY As a member of the Enterprise Risk Management (ERM) organization at MassMutual, you will partner with multiple business areas to conduct independent deep-dive validation efforts, recommend and oversee gap remediation and process improvement activities for a wide variety of actuarial models that are integral to our product pricing and repricing, Statutory and GAAP financials, risk mitigation activities, decision support and profitability. You will also have the opportunity to understand all areas of the insurance model functions and positively impact model development, implementation and management practices to help strengthen and mature model governance functions across the organization.
RESPONSIBILITIES + Conduct deep-dive independent validations of actuarial models, including valuation, and product pricing related models, in accordance with corporate model governance policy requirements.
Build benchmark (blueprint) applications to effectively challenge the models under validation by replicating their results and conducting sensitivity analysis / scenario testing and stress testing to identify potential limitations to model concepts, design and methodologies and their continued applicability to evolving economic environments and changes accounting, actuarial and other governing and regulatory bodies.
Prepare and distribute model validation reports, which meet the model governance expectations, while working collaboratively with model owners, business unit management and other stakeholders throughout the validation process.
Assess model design, theoretical construction and efficiency of data flow and processing, identify flaws and recommend improvements.
Validate model calculations, algorithms and any embedded automation / programming code base.
Evaluate model inputs, appropriateness of assumptions and embedded methodologies for potential weaknesses, including data relevance, completeness, conceptual soundness, etc.
Validate model output appropriateness and reasonableness under changing conditions and identify issues requiring further investigation.
Test remediation of validation findings, monitor and report on the ongoing model performance relative to benchmarks.
Proactively drive model inventory management and reviews, completeness and accuracy testing, risk evaluations and ranking, risk control implementation reviews, including documented gap mitigation plans, status and progress reporting.
The models include those used within several actuarial, risk management and product management business units supporting multiple products (e.g. whole life, universal life, term, annuities, disability income, long-term care, retirement, employee benefits, etc.) and business processes, such as reserves / valuation, deferred acquisition costs (DAC), cash flow testing (CFT), dividends, pricing, repricing, forecasting, asset liability management , risk appetite, etc.
QUALIFICATIONS + 4+ years’ actuarial experience with life insurance and / or retirement products.
ASA, CERA or actuarial rotational student working toward designation (minimum 2 exams completed).
Effective operational knowledge of actuarial principles, modeling, methods, workflows and risks.
Systematic thinking to quickly and holistically understand products, procedures, and risks + Inquisitiveness, critical thinking, professional skepticism, and business sense.
Discernment to detect real exposures and patience to avoid ‘false positives’ + Strong oral and written communication skills, including ability to communicate complex issues to non-technical stakeholders.
Experience with sophisticated actuarial models.
Ability to work individually and collaboratively.
Knowledge of programming languages (e.g. R, Python, SQL, C++, APL) and actuarial systems (e.g. GGY Axis) is a plus.
Candidates must be authorized to work in the United Stateswithout requiring visa sponsorship
PREFERRED QUALIFICATIONS + Proficiency with MS Office products, including VBA, is required. MassMutual Financial Group is an Equal Employment Opportunity employer Minority/Female/Sexual Orientation/Gender Identity/Individual with Disability/Protected Veteran. We welcome all persons to apply. MassMutual provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, gender, sexual orientation, gender identity or expression, national origin, age, disability, genetic information, marital status, citizenship status, ancestry or status as a protected veteran in accordance with applicable federal, state and local law. MassMutual complies with applicable federal, state and local law governing nondiscrimination in employment in every location in which the company has facilities. EEO applies to all terms and conditions of employment, including, hiring, placement, promotion, discipline, termination, leaves of absence, compensation and training. MassMutual also has affirmative action programs designed to achieve equal employment opportunity for minorities, women, individuals with disabilities and protected veterans. Human Resources is responsible for the design, implementation, communication, and monitoring of affirmative action and other equal employment opportunity programs.
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Senior Associate Actuary
Description: Position Purpose: Conduct analysis, pricing and risk assessment to estimate financial outcomes. Manage health plan specific actuarial needs and produce actuarial reports to aid in developing corporate strategy.
Serve as the main point of contact for all actuarial related activities for multiple health plans + Apply knowledge of mathematics, probability, statistics, principles of finance and business to calculate financial outcomes + Develop probability tables based on analysis of statistical data and other pertinent information
Research and analyze the impact from legislative changes + Analyze and evaluate required premium rates + Assess cash reserves and liabilities enable payment of future benefits + Analyze various data reports, identify trends and gaps and recommend action
Determine the equitable basis for distributing money for insurance benefits + Create and update actuarial reports, and manage the dissemination of reports between departments and health plans + Participate in merger and acquisition analysis
Qualifications: Education/Experience: Bachelor s degree in related field or equivalent experience. 5 years of actuarial experience. License/Certification: Associate of the Society of Actuaries (ASA) Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.
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Assistant Actuary - Model Development
How do we make Every Day Matter? At Legal & General America, we strive to create that unique environment where balance between work and life is possible. Imagine that! Integrity, quality and value are behind every business decision we make and are at the forefront of what drives us. We genuinely care about our customers, agencies, fellow employees and local community. We set big goals for ourselves, personally and professionally. Reaching them means seizing the day, challenging ourselves and making Every Day Matter. Pretty simple concept, if you ask us.
Purpose and Objective Implement and maintain GGY AXIS asset models for LGA’s asset portfolios and various asset/liability modeling applications, including those used in Corporate Planning, Embedded Value, Economic Capital, Cash Flow Testing, and VM-20. In addition, assist in the documentation and control of all the model development activities required by the upcoming Model Risk & Control Framework (MRCF).
Essential Responsibilities + In the initial stage, build asset model in GGY AXIS for a variety of purposes, including Economic Capital, Embedded Value, Cash Flow Testing, Corporate Planning/Forecasting, and VM-20 (deterministic and stochastic reserve calculation). Refine the existing asset module datalink. Model structured assets in Moody's Analytics software separately and incorporate the results into AXIS via either externally projected asset files or dynamic link. Also implement reinvestment strategies and reinvestment assets for the above projections.
For Economic Capital, work with our EC/Solvency II team to build a process in AXIS to be able to stress asset under different scenarios at different granularity that meets their needs.
Test the models to ensure that they are appropriately built by validating against existing ALFA asset models. Customize AXIS reports and reporting tools to produce the required model output. Ensure implementation of models complies with satisfactory standards and timeframes.
After implementation, be responsible for quarterly asset model update, which includes running Moody's Analytics software for structured assets, stressed asset modeling for EC, updating all investment/reinvestment assumption, model enhancements, model documentation, and adding new asset types or reinvestment assets when needed. Analyze change in the projected earned rates.
Run models or assist in modeling for all the production work requirements, depending on the resource needs of each reporting cycle.
Ensure model control is compliant with the latest corporate model control and governance standard. Prevent unauthorized changes and ensure integrity of model results. Maintain detailed documentation of all changes made to models, including impacts under key reporting bases and evidence of management approval.
Identify and implement process improvements, including automation of manual tasks where possible, to increase efficiency and transparency while minimizing the risk of errors.
Associate, Society of Actuaries
Experience/Knowledge + 5 years of life insurance/actuarial experience + Minimum of 2 years Asset Modeling experience preferred + Model development or modeling experience preferred.
Experience in various asset/liability modeling applications preferred. Skills + Actuarial software skills – GGY AXIS experience is a key requirement (datalink coding experience highly desired), BondEdge and/or MG-ALFA a plus.
Spreadsheet and database capabilities (Excel, MS Access, VBA, SQL).
Strong actuarial analytical skills and problem solving ability + Proficient written and oral communication skills.
Ability to multi-task in a deadline-oriented environment Job ID: 2017-1742 External Company Name: Legal and General America, Inc. External Company URL: www.lgamerica.com
Health Associate Actuary - Tampa, FL
The Tampa, Florida office of Milliman, an international firm of actuaries and consultants is seeking an actuarial candidate. This role would involve assisting consulting actuaries with a wide variety of tasks including pricing, reserving and forecasting. This position provides excellent opportunities for professional development and advancement. Who We Are The Milliman – Tampa Supplemental Products Team is a practice within Milliman, Inc., one of the largest actuarial consulting firms in the world. Our team was established in 1998 specializing in supplemental health products. Since that time we expanded our expertise with the addition of several senior actuaries who have spent their entire careers focused on these supplemental health and life product lines. We provide a wide range of services including product development support, pricing, experience analysis, product re-rating as well as valuation and appointed actuary work. Job Description: + Technical expertise with ability to actively participate in multiple consulting projects simultaneously.
Wide variety of assignments, including pricing, product design, merger & acquisition support, statutory and tax valuation and/or ORSA support.
Product development and support experience in some or all of the following product areas: + Critical Illness, + Accident, + Hospital Indemnity, + Combination Life/Health products, and/or + Other supplemental products + Mentor entry-level actuarial staff.
Opportunity for some travel. Qualifications:
Strong academic background in Actuarial Science, Finance, Statistics, Economics, Mathematics or other related degree.
Associate of the Society of Actuaries (ASA) + Four or more years actuarial experience preferred.
Strong work ethic and ability to work independently.
Proven ability to handle multiple projects and tasks, prioritizing and meeting deadlines.
Prior experience with valuation (statutory and/or GAAP), product pricing, experience analysis or re-rating.
Strong written and verbal communication skills are required.
Experience with actuarial software applications is desired (preferably MG-ALFA).
Prior consulting experience is a plus, but not necessary. Milliman offers a high-performance but relatively casual work environment in Tampa. We offer competitive salaries and excellent benefits. About Milliman Milliman is among the world’s largest independent actuarial and consulting firms. With more than 3,200 employees and revenues of US$905 million in 2015, the firm serves the full spectrum of business, governmental, and financial organizations. Founded in 1947, Milliman today has offices in principal cities worldwide, covering markets in North America, Latin America, Europe, Asia and the Pacific, the Middle East, and Africa. Milliman, Inc. is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color sex, sexual orientation, gender identity, religion, national origin, age, protected veteran status, disability status, or any other characteristic protected by law. Equal Opportunity Employer/Protected Veterans/Individuals with DisabilitiesThe contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor’s legal duty to furnish information.QualificationsRequiredPreferredLicenses & CertificationsRequiredPreferred
Job Details: Associate Actuary
Job Details: Associate Actuary On-Line Application + + + + Vacancy NoVN1663 Posting TitleAssociate Actuary Location CityBoston Language Requirement Job Description Position Summary This position will be a member of one of the three functional areas of the Actuarial Services department, supporting Financial Reporting, Trend Analytics, or Provider Analytics. This position will be responsible for extracting and summarizing data from various sources including our data warehouse and research resources. Additionally, this position will create first draft of analytic models that will be guided by and reviewed by more senior staff. Key Responsibilities
Lead analysis and monitoring of provider contracts including administrative services only, full-risk and shared risk arrangements.
Lead analysis and monitoring of CMS and MassHealth fee schedule changes.
Lead analysis of impact of benefit changes.
Lead work with Clinical to quantify the financial impact of changes in clinical approach, provider supply, induced demand and other factors both prospectively and retrospectively. + Utilize and evaluate internal and external data sources to better understand market drivers and cost trends.
Support rate discussions with Medicaid agency by providing an understanding of adequacy of rates for individual rate cells and at the product level; Identify factors that contribute to or may contribute to rate inadequacy.
Development of budget for claims expenses and revenues; Requires working collaboratively with various individuals across the organization to understand impact of anticipated changes to operations as well as an understanding of changes in external environment.
Monitoring of actual experience compared to budget with explanations for drivers of variance. Minimum Qualifications + ASA or near-ASA.
3-8 years direct experience.
Strong knowledge of care management and healthcare industry practices.
Strong actuarial, analytical and problem-solving skills.
Ability to work under pressure and tight deadlines.
Strong interpersonal and communication (verbal & written) skills.
Ability to communicate business and technical information to people of various backgrounds.
Distinguishes true sense of urgency.
Ability to communicate directly and build trust with senior leaders essential.
Initiative, work ethic, ambition, and an appetite for challenging and often unstructured assignments.
Ability to be flexible, accommodating shifting priorities and demands, and reacting quickly to developing issues.
Proactive and collaborative. ALL APPLICANTS SHOULD SUBMIT A COVER LETTER WITH APPLICATION. Please note employment with CCA is contingent upon acceptable professional references, a background check (including Mass CORI, employment, education, criminal check, and driving record, (if applicable)), an OIG Report and verification of a valid MA/ RN license (if applicable). Commonwealth Care Allianceis an equal opportunity employer. Applicants are considered for positions without regard to veteran status, uniformed service member status, race, color, religion, sex, national origin, age, physical or mental disability, genetic information or any other category protected by applicable federal, state or local laws. #LI-IB1
Highmark Inc Job Description : GENERAL OVERVIEW: This position prepares, performs and analyzes actuarial studies and processes.
Apply actuarial techniques and statistical analysis to at least one of several functions such as insurance premium and pricing development, claim trend analysis, experience studies, medical economics analysis, profitability analysis, wellness studies, predictive modeling, and claim reserving. ESSENTIAL RESPONSIBILITIES: 1. Prepare studies, analyses, and presentations to allow management to make informed business decisions for both internal and external customers. 2.
Establish quality control processes around all work, analysis, and models. Continually enhance their company and industry knowledge to apply appropriate reasonableness checks. 3. Propose and develop improvements to existing processes that align with the goals and objectives of the department and company. 4.
Pull, summarize, and analyze data from internal databases. 5. Perform all work in accordance with applicable laws, regulations, and actuarial professional standards. 6. Perform ad hoc actuarial projects and other duties as assigned or requested. 7.
May assist with training new employees. 8. Other tasks as required. QUALIFICATIONS: Minimum + Bachelor’s degree in Actuarial Science, Mathematics, Statistics, or a closely related field is required for all levels + Generally possesses 3-5 years of relevant, progressive experience in the area of specialization.
Grandfathered experience requirements effective August 2016. Preferred + None Knowledge, Skills and Abilities + Knows and applies principles, practices, and processes within the specific field or discipline. Building higher-level knowledge and skills. Gathers and analyzes information, designs and tests solutions to problems, and formulates plans.
- Performs work that is varied and somewhat difficult. Solves a range of problems by analyzing possible solutions using standard processes.
SCOPE OF RESPONSIBILITY Does this role supervise/manage other employees? No WORK ENVIRONMENT Is Travel Required? No ---------------------------------------------------------------------------------------- Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities, and prohibit discrimination against all individuals based on their race, color, religion, sex, national origin, sexual orientation/gender identity or any other category protected by applicable federal, state or local law.
Highmark Health and its affiliates take affirmative action to employ and advance in employment individuals without regard to race, color, religion, sex, national origin, sexual orientation/gender identity, protected veteran status or disability. EEO is The Law Equal Opportunity Employer Minorities/Women/Protected Veterans/Disabled/Sexual Orientation/Gender Identity ( http://www1.eeoc.gov/employers/upload/eeoc_self_print_poster.pdf ) We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact number below.
For accommodation requests, please call HR Services at 844-242-HR4U or visit HR Services Online at HRServices@highmarkhealth.org Highmark Health and its subsidiaries and affiliates comprise a national health and wellness organization that employs more than 40,000 people and serves nearly 50 million Americans in all 50 states and the District of Columbia. The organization includes businesses in health insurance, health care delivery, managed vision care, retail eyewear and eye care services, eyewear manufacturing, dental solutions, health risk solutions, and innovative, technology-based solutions. Highmark Health is the parent of Highmark Inc., Allegheny Health Network, HM Health Solutions, and HM Home and Community Services LLC.