Actuarial Analyst II - Health - 9678
New position created where client is looking to add an actuary with health industry expereince. The Actuarial Analyst II will report directly or indirectly to the Chief Actuary and support the actuarial function. The position will be responsible for: support of month-end and year-end financial reporting, including IBNP, risk sharing, and other related Actuarial valuation tasks; support of the annual budget process; support of the multiple Rate Development Template processes throughout each year; review and analysis of rate development models, risk adjustment, or risk sharing arrangements provided by California Department of Health Care Services (DHCS), Centers for Medicare and Medicaid Services(CMS), California Health Benefits Exchange (HBEx), or other government and non-government sources; development of capitation rates and risk sharing targets; writing or review of contract language pertaining to capitation rates, risk adjustment, risk sharing, or other actuarial topics written into subcontractor agreements; analysis of health care costs and health care trends; documentation of previously noted tasks; other actuarial duties as required. The Actuarial Analyst II will occasionally need to make presentations to non-Actuarial staff.
Support the monthly Financial Reporting Process, including Incurred But Not Reported (IBNR) estimates, risk sharing, risk adjustment, and premium revisions. Assist the Accounting Dept. with the monthly Close. Document processes as needed. Assist Accounting with financial audits from State and Federal agencies, as well as our procured Audit firms.
Gather data, perform analyses, and complete reports as directed by the Chief Actuary or other senior Actuarial staff, for both regular monthly reporting or ad hoc reporting needs. Reports will emphasize incurred costs (date of service) and provide explanations, where possible, for counter-intuitive results.
Support the annual Budgeting process, develop projections (including projections of health care trend) and prepare reports for the Budgeting staff. Prepare clearly identified analyses which support the projections, and explain major assumptions.
Review revenue rate (premium) worksheets from California Department of Health Care Services (DHCS), Centers for Medicare and Medicaid Services(CMS), or other government agencies which provide client's health care cost related revenue. Review assumptions and calculations of the government's Actuarial staff. Assist the Chief Actuary or other senior Actuarial staff, or senior management staff, in rate negotiations with the government.
Assist the Law Dept. and Provider Contracting staff with preparation and review of contract amendments for client's subcontracted health care providers, quantify changes in benefits and/or scope of coverage, provide language for complex contractual arrangements such as risk sharing or risk adjustment.
Ideal candidate will have 3 exams plus 1 year; or 2 exams plus 2 years. Experience must be under the direct supervision of a credentialed Actuary. Exams must be those administered by the society of actuaries. Medicare experience is a MUST for this role as is Excel experience.