The Actuarial Consultant is a key member of the Finance / Actuarial Services team. As an independent contributor and a Subject Matter Expert, the Actuarial Consultant oversees actuarial functions for pricing, reserving, medical economics, financial forecasting, and/or healthcare data analytics. The Actuarial Consultant collaborates with Finance teams or other departments in the organization to oversee and assure a coordinated approach to the actuarial components of health programs, and provides actuarial expertise to protect the organization’s financial integrity.
KEY FUNCTIONS/RESPONSIBILITIES:
- Leads the rate development process by providing analyses and recommendations on benefit design, rating factors, trend picks, and projection of future claim cost.
- Oversees regulatory rate filings, and prepares data or response for additional inquiries.
- Leads the development of monthly IBNR reserve estimates for different line of business.
- Oversees monthly accruals and contract settlements for different line of business.
- Leads financial budget, reforecast and other financial projections.
- Evaluates and makes recommendations regarding the adequacy of capitation rates from state Medicaid programs or other new program.
- Coordinates with various departments and cross-functional teams to capture, value, and scorecard medical cost savings initiatives.
- Leads risk adjustment analyses and risk score simulations.
- Leads trend development, trend drivers study, and/or provider contract analytics.
- Maintains financial relationships with vendors and providers. Represents Finance in negotiations of financial terms to support network contracting strategy or outsourcing strategy.
- Develops analytic reports for internal needs and/or regulatory requirements.
- Initiates and leads efforts to improve quality and efficiency of actuarial models, analyses and reports.
- Summarizes findings and makes recommendations.
- Develops presentations and communicates to senior management or external parties.
- Leads response to internal and external audits.
- Serves as actuarial representative or SME for corporate initiatives/projects.
- Advises Finance department on data warehouse designs, requests and works with IT to implement or improve business processes.
QUALIFICATIONS:
EDUCATION:
- Bachelor’s Degree in Mathematics, Actuarial Science, Finance, Economics or related fields.
EXPERIENCE:
- More than 5 years of progressively responsible experience in actuarial analysis, data modeling, informatics and analysis.
PREFERRED/DESIRABLE:
- A background in managed healthcare, insurance operations.
- Master’s degree.
- ASA or FSA
COMPETENCIES, SKILLS, AND ATTRIBUTES_:_
- Proficient in Excel, SQL, and SAS or other statistical software.
- Strong interpersonal skills to lead and direct the efforts of others, both internally and externally.
- Strong analysis skills. Must be able to conceptualize and envision the impact of change, and propose new ways to do business.
- Ability to meet deadlines, multi-task, problem solve and use appropriate technology to analyze business problems. Project management skills a plus.
- Strong communications skills, both verbal and written.
*Qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, disability or protected veteran status.
Required Skills
Required Experience