Senior Actuarial Analyst

Martin's Point Health Care Portland , ME 04101

Posted 4 weeks ago

Join Martin's Point Health Care - an innovative, not-for-profit health care organization offering care and coverage to the people of Maine and beyond. As a joined force of "people caring for people," Martin's Point employees are on a mission to transform our health care system while creating a healthier community. Martin's Point employees enjoy an organizational culture of trust and respect, where our values - taking care of ourselves and others, continuous learning, helping each other, and having fun - are brought to life every day. Join us and find out for yourself why Martin's Point has been certified as a "Great Place to Work" since 2015.

Position Summary

This position provides a wide range of actuarial expertise and support to the company, including to Medicare Bids to CMS and USFHP rate setting with the Department of Health Administration (DHA). This position is responsible for reporting and analysis as directed by the Senior Actuary. The role will involve data collection, reconciliation, review/evaluation and reporting in appropriate formats to highlight operational performance. Additionally, this position will leverage expertise and experience to act as consultant to the business and must function well in a matrix management environment.

Job Description

Key Outcomes:

  • In conjunction with Senior Actuary, Generations Advantage (GA) leadership, and EMT, analyze, develop, and submit Medicare Advantage and Prescription Drug (MA/PD) plan Bid Pricing Tools (BPTs) in compliance with CMS regulations and timelines to meet corporate objectives for growth and profit margin.

  • Collaborate on estimates for Risk Revenue. Monitor changes and updates to the risk adjustment approach employed by CMS.

  • Prepare valuation analyses including claims Incurred But Not Paid (IBNP), Medicare Part D Reconciliations, Provider Incentive Liabilities, Risk Revenue Accruals, and Provider Partner Risk Settlements.

  • Support Finance related Part C and Part D reporting requirements for Medicare.

  • Support budget and forecast development of revenue, medical expense, and pharmacy expense.

  • Provide insight and analysis to support the USFHP annual rate development.

  • Provide insight and analysis of medical expense, consulting with Senior Actuary, medical management leadership, and product leadership to develop action plans.

  • Develop and maintain knowledge and expertise in regional and national managed health care trends and best practices, seeking opportunities to translate those to Martin's Point.

  • Consult to key financial arrangements that pertain to health plan partners' alternative payment models.

  • Assess variances between projected and actual experience.

  • In conjunction with Senior Actuary, support senior management (Chiefs and VPs) with special projects and research, including compiling white papers on special topics, as needed.

Education/Experience:

  • Bachelor's degree in actuarial science, math, statistics or a related field is required.

  • 5-8 years of progressive actuarial experience in a managed care setting, with exposure to a wide range of health care actuarial concepts, including valuation, pricing, and trend analyses.

  • Experience developing and managing a wide array of financial arrangements is preferred.

Exclusion from Federal Programs

Employee may not at any time have been or be excluded from participation in any federally funded program, including Medicare and Medicaid. This is a condition of employment. Employee must immediately notify his/her manager or the Clinic's Compliance Officer if he/she is threatened with exclusion or becomes excluded from any federally funded program.

Skills/Knowledge/Competencies (Behaviors):

  • Demonstrates an understanding of and alignment with Martin's Point Values.

  • Strong analytical skills.

  • Demonstrated interpersonal, communication, and team building skills.

  • Strategic ability to see the big picture and connect dots across mathematical and financial relationships and across an organization.

  • Proven ability to organize work, simultaneously work on many activities and projects, and meet deadlines directly and through matrix management.

  • Strong track record of building internal and external collaborative relationships.

  • Broad understanding of managed care business and actuarial and financial principals such as underwriting, medical management, physician reimbursement, risk adjustment, pharmacy management, balance sheet valuation, risk management, and alternative payment models.

  • Strong oral and written communication to support senior leader level briefings and presentations both internal and external to Martin's Point.

We are an equal opportunity/affirmative action employer.

Do you have a question about careers at Martin's Point Health Care? Contact us at: jobinquiries@martinspoint.org


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Senior Actuarial Analyst

Martin's Point Health Care