Senior Healthcare Actuarial Consultant

Senior Healthcare Actuarial Consultant

Candidate needs to be based in one of the following states- MN, TX, FL, NY (work remote for most part)

6+months

Will lead actuarial workflows in support of ACO REACH & MSSP performance evaluation and forecasting. In addition, this role leads value-based contracting (VBC) workflows to include evaluation and forecasting of full and partial risk arrangements between affiliated providers and payors from multiple LOBs (Commercial, Medicare Advantage, Medicaid, etc.). Additional cross-functional support role working with Line of Business, Analytics, Finance, Marketing and other areas of the company that may need data summarization, modeling framework or research help.
ROLE RESPONSIBILITIES

• Support the Government Programs & Provider Risk Actuarial Models team's development of actuarial models to be used for medical expense and trend analysis and forecasting, provider risk contract evaluation, and ACO REACH / MSSP performance evaluation.
• Lead quarterly medical expense analysis, IBNR / Reserving (monthly), and forecasting process, with assistance from actuarial analyst staff.
• Document and present summary review memos in support of the quarterly medical expense analysis and forecasting process in preparation for, and as follow up to, collaboration with various owned clinics and SMEs and leaders.
• Lead the evaluation of financial implications of provider participation in networks for ACO REACH / MSSP opportunities.
• Lead provider risk contract evaluations and ACO REACH / MSSP performance evaluations, interfacing with internal team and external consulting actuaries.
• Collaborate with Finance team in the development of forecasting models, projections and relevant information to inform C-Level business decisions.
• Lead the development of contract analysis assumptions to inform contract evaluation decisions and plan benefit development and provide guidance to the owned clinics teams.
• Perform ad-hoc data analysis using Excel, SAS, SQL (Databricks).
• Other duties and responsibilities as assigned.

EDUCATION, TRAINING, AND PROFESSIONAL EXPERIENCE

• Bachelor's degree required in Math, Statistics, Economics, Actuarial Science, or a related field
• 4+ years of actuarial experience with 5+ years working within healthcare
• 2+ years working with a CMMI ACO Model (of any kind) is strongly preferred
• 2+ years performing medical IBNR / Reserving calculations is strongly preferred
• 2+ years working with individual/small group ACA rate filings or Medicare Advantage bids is preferred
• Working knowledge of the CMMI Direct Contracting or Accountable Care Organization (ACO) program(s)
• Working knowledge of industry value-based contracts between payers and providers (risk sharing arrangements)
• Experience leading projects and ownership of deliverables

PROFESSIONAL COMPETENCIES

• Proficient in Microsoft Excel (VBA, advanced data visualization, etc.) and other Office products
• Experience with forecasting, modeling, SQL (Databricks experience is a plus)
• Understanding of company practices related to management of member populations for purposes of estimating risk
• Produce, understand, and interpret internal and external analysis and reports; provide effective technical and non-technical support to internal and external stakeholders

LICENSURES AND CERTIFICATIONS

• Associate of the Society of Actuaries is required.