Senior Actuarial Analyst (Health) Remote - 9415
Health care organization on the West Coast has a need for a Senior Actuarial Analyst. This role will involve delivering complex quantitative analysis for financial, clinical and network contracting strategic initiatives, business development and unit cost management activities through financial modeling analysis of utilization and reporting. The incumbent will conduct complex unit cost and contract valuation analysis in support of payer/provider negotiations, medical cost management strategies, recommendations in managing unit cost budgets, target setting, performance reporting and financial models and benchmarks. The role will serve as the lead in partnering with multi-faceted departments providing high level business intelligence and analytics requirements of varying disciplines.
· Performs complex analysis of actual financial and statistical results, completes financial forecast/planning, and applies analytical capabilities and business acumen to recommend courses of action that enable the business unit to meet financial and business objectives
· Serves as a technical expert in data mining and extraction using a variety of software tools and sources to include but not limited to: electronic health record, eligibility, or claims data. Collects, analyzes, interprets, and presents comparative clinical and cost data, integrates benchmark information
· Identifies, investigates, and communicates cost and utilization patterns for inefficiencies and potential opportunities to help reduce overall total cost of care
· Analyzes key trends and performance related to clinical programs, provider network performance, other programs or practices, and providers of health care
· Serves as an internal consultant regarding the refinement of data collection and analytic procedures used to provide business intelligence and decision support
Prerequisites: Advanced skills in statistical analysis, reporting cycle, project management, customer service and consultative skills are critical to the success of this position; Strong ability to utilize benchmarking data including internal metrics/targets to advise on best practices and integrated reporting; Expert knowledge of predictive analytics/actuarial techniques to model future costs of current and emerging products programs, risk types and public health behavior; Advanced knowledge of Microsoft Access and Excel, SQL, BI tools and data warehousing strategies for reporting purposes. Candidates also need the following: Bachelor’s Degree in a quantitative discipline; Extensive experience working with: data and actuarial models, managed care applications, financial modeling in payer/provider negotiations and medical cost management strategies. Candidates with a Master’s Degree in business, health or public administration, management or similar is ideal. Extensive experience in the healthcare industry either working in a hospital health plan or managed care environment is preferred. ASA designation is preferred but actuarial exams are not required for the position.