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Our Mission is to Make Healthcare Right. Together. Built upon the belief that by connecting and aligning the best local resources in healthcare delivery with the financing of care, we can deliver a superior consumer experience, lower costs, and optimized clinical outcomes.
What drives our mission? The company values we live and breathe every day. We keep it simple: Be Brave. Be Brilliant. Be Accountable. Be Inclusive. Be Collaborative.
If you share our passion for changing healthcare so all people can live healthy, brighter lives – apply to join our team.
SCOPE OF ROLE
The Actuarial Analyst II will work directly with the state market lead, state market MCM lead, the actuarial economics team, clinical leads, network leads and MCM initiatives team to identify all areas of emerging opportunity to reduce or improve unit cost positions and utilization outliers in support of all budget and pricing goals. Products overseen include IFP, Medicare Advantage, Small/Large Group, and any other future product started in an assigned market(s). This role will also interface with the lead pricing actuaries to ensure pricing actions and Actual-to-Priced-For reporting is current on all initiatives in process at a market and state level.
- Conduct all necessary analysis to identify all drivers of medical expense trends on a PMPM, utilization, and unit cost basis for assigned market(s), including regional differences, providers involved, and any other material view necessary to explain actual and emerging claim experience
- Integrate all “early warning” data available in the organization into analysis approach to ensure emerging trends are identified and addressed as they occur
- Provide analytical support as needed for provider contract negotiations, including risk and value-based arrangements
- Work directly with assigned market MCM leader and market leadership team to provide the data analysis necessary to support their local MCM initiatives agenda and performance against budget/forecast
- Work directly with the national Director of MCM and VP of Field Finance to ensure the program for the identification of all MCM opportunities is maximized and works efficiently for all stakeholders
- Provide analytical support and interface with market and national clinical leadership to ensure all utilization trends and possible solutions are identified
- Perform ad-hoc data analysis as needed to support market and state objectives
- Support the Actuarial team on all project work related to complex trends while also interfacing with internal and external stakeholders
- Work directly with pricing team to ensure all requisite MCM initiatives are appropriately analyzed and valued for inclusion in all pricing activities
EDUCATION, TRAINING, AND PROFESSIONAL EXPERIENCE
- Bachelor’s degree required in Math, Statistics, Economics, Actuarial Science, or a related field
- 2-4 years of actuarial experience with 2+ years working within healthcare
- 2+ years working with individual ACA rate filings if preferred, but small group ACA experience would suffice
- Experience leading projects and taking ownership of deliverables is preferred
- Advancing towards ASA credentials
- Proficient in Microsoft Excel and other Office products
- Experience with SQL and/or SAS
- Working knowledge of healthcare pricing process for commercial products
- 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
- Must be a self-starter and be able to work both as part of a team and individually
LICENSURES AND CERTIFICATIONS
- Associate of the Society of Actuaries is preferred, but not required
We understand patient pain points, eliminating complexity while increasing transparency, for greater access and easier navigation.
We integrate and align individual incentives at all levels, from financing to optimization to delivery of care.