Manager, Healthcare Analytics-8529
Client looking for a Manager, Healthcare Analytics & Actuarial due to growth and overall expansion. This role will lead the financial analysis of the health plan's performance and oversee the operations of the Finance and Analytics function.
Help develop, implement and monitor the health plan's strategic plan and annual budget.
Review and interpret plan's financial performance. Monitor actual to budget performance.
Develop and prepare management reports. Responsible for daily operations of Medical Data Management functions, including systems. Review and analyze premium rates received from the State. Develop analysis and arguments to support rate negotiations. Monitor risk adjustment factors applied to rates and evaulate the financial impact of periodic adjustments.
Review and analyze medical cost performance, including provider contract and medical management efficiency, identifying and implementing opportunities for improved profitabilty.
Review and analyze monthly claims reserves for accuracy. Assist corporate actuarial department in setting monthly claims reserves.
Perform studies related to medical care costs and trends. Support projects related to rate filings, new business development, financial projections and budgeting.
Review and analyze financial terms of provider contracts and recommend changes.
Manage reporting in areas of provider unit cost performance and unit cost management.
Assess the accuracy of provider reimbursements, including claims capitation, and incentive payments.
Ideal candidate will have 5+ years of healthcare finance and/or actuarial/analytical experience.
Managed care experience preferred as well as experience working with Medicaid.
3+ years of supervisory/management experience.
3+ years of SQL and/or programming skills