Provides actuarial services in support of the Provider Network Management and Clinical areas. With specific responsibilities of providing data, analytics and reporting in support of provider contracting and value-based reimbursement arrangements, providing data and analytics in support of vendor management and relationships, analyzing trends and interpreting results for matrix partners, supporting contract negotiations and interpreting results/impacts using data, identifying root causes and opportunities for medical and pharmacy cost savings.
Support ongoing financial analysis and reporting on various provider contracts and Value Based reimbursement arrangements, e.g. ACO Shared Risk/Shared Savings arrangements
Provide data and analysis in support of third-party delegate management, from the RFP phase through post-implementation performance tracking and financial oversight (e.g. with ancillary risk vendors, global risk entities)
Provide data and analytics in evaluating / validating total medical and pharmacy cost savings in support of the Health Care Cost Containment Initiatives (HCCI) process.
Analyze, understand, and explain trend variances. Identify opportunities/initiatives to reduce medical costs.
Provide other actuarial analysis as required to Provider Contracting area.
Regular attendance is an essential function of the job. Performs other duties as assigned or required.
Bachelor's degree in Economics, Mathematics, or similar major required; advanced degrees a plus
Minimum of 2 Society of Actuaries exams passed
Proficient in Excel required; SAS preferred
1-2 years health insurance actuarial experience, preferably in the managed health care industry required
Intermediate understanding of actuarial principles and methodologies along with good mathematical and analytical skills required
Highly proficient in the application of spreadsheet and database management software required
Familiar with medical trend analyses required
Excellent communicator required
Demonstrated ability to learn and adapt required
Demonstrated team player required