Description

This position will perform actuarial analyses for Commercial, Medicaid and Medicare business including, but not limited to medical expense analyses and projections, determining rates and preparing supporting documentation for rate filings with DOI, pharmacy analytics and projections, building and maintaining rate models, analyzing data in support of monthly reserve process, and ad hoc actuarial analyses. In addition, this position will work closely with the legal department to identify, size, and communicate financial risks and opportunities related to legislative and regulatory changes including impacts to premiums, benefits and product designs.

Essential Functions

• Lead in pricing products across commercial and Medicare lines of business
• Closely monitors and assesses competitors' rates, trends and rating methodologies
• Supports various initiatives as needed by actuarial modeling
• Develops/enhances ad hoc reports to assist in actuarial analyses of emerging results
• Creates and maintains large databases of information utilizing a unique skill set of spreadsheet and relational database abilities
• Lead in setting and documenting financial liabilities including IBNR Reserves, PDR, Risk Adjustment and other outstanding items
• Conducts cross-functional analysis of health care data to identify trends and risks
• Develop data and reports in support of reinsurance, risk adjustment and risk corridors, ensuring accurate impacts in pricing and coordination with rebate determination
• Assess the financial or pricing impact of variations in benefits and provider contracts  
• Estimate mandated benefit cost and calculate pricing of benefit changes
• Tracks trends and reports pertinent financial and utilization information
• Perform other related projects and duties as assigned
• Participate in yearend ORSA reporting
• Mentor junior members of staff
• Manage actuarial projects across different areas of the business
• Assist in setting targets for value based arrangements
• Manage all deliverables from actuarial department
• Lead staff in prioritizing projects and meeting deadlines

Requirements

Bachelor's Degree required, preferably in Actuarial Science/Mathematics/Finance/Healthcare Management or a related field or an equivalent combination of education and experience.

• Associate in Society of Actuaries, Fellow preferred
• 7+ years of previous experience
• Excellent quantitative, problem solving and analytical skills.
• Strong communication skills.
• Technical skills with database concepts, data analysis development, data warehousing and decision support tools.
• Knowledge of MS-Office products, SAS or SQL required.