Actuary - Health - 9548
Nonprofit Medicaid/Medicare health plan looking to add an Actuary to their team. Position reports into the Actuarial Services Manager. Position must be based in Oregon.
This position is responsible for performing a wide variety of financial and actuarial analyses impacting strategic decision making and the company’s financial sustainability efforts. Areas of analysis include cost and utilization trend analysis, return on investment evaluations, Medicare bid development, rate setting optimization, forecasting support, benchmarking, risk adjustment optimization, provider payment evaluation and review of actuarial estimates such as IBNR and PDR.
Financial and Actuarial Analyses
Drill down into cost and utilization trends to identify key drivers.
Develop profitability analytics to support evaluation by provider group, contract and other valued indicators.
Design, develop, and implement evaluation tools in measuring the effectiveness of programs and payment models.
Develop cost savings calculators for use in goal setting, budgeting and forecasting
Provide rate setting support through data analysis, policy review and strategy development.
Identify any actuarial unsound adjustments to the rates.
Provide medical cost and utilization trend recommendations for forecasting purposes.
Gather and develop benchmarks for purposes of assessing our performance and the potential for improvement.
Monitor risk adjustment applied to capitation revenue and ensure population risk is appropriately represented in encounter data.
Evaluate provider payment models, including risk share arrangements, to ensure they achieve the desired outcome.
Prepare regular risk share reporting for sharing with providers and supporting accounting estimates.
Drive strategic use of data to support business efficiencies and competitive decision-making.
Review and provide guidance on actuarial estimates of IBNR, PDR and other actuarially determined assets and liabilities.
Financial Analytical Capacity and Capability
Develop and execute methodologies for new projects.
Create documentation for new models and projects.
Summarize analyses into actionable recommendations.
Education and/or Experience
Bachelor’s Degree in Finance, Mathematics, Economics or related field
Associate of the Society of Actuaries
Minimum 4 years’ experience in an actuarial role.
Work experience in health insurance