Pharmacy Actuarial Associate

This is a key role responsible for connecting deep pharmacy expertise with actuarial principles relating to health plan risk and pricing. This position is a senior member of the team responsible for:
*Owning and driving initiatives and analyses related to formulary strategy and pharmacy pricing.
*Measuring clinical programs and evaluating pharmacy claims data to identify cost drivers and
opportunities for cost containment.
*Assessing drug and class-specific initiatives.
*Pharmacy analytics evaluating emerging results, trend drivers, evaluating the drug pipeline, and
drug trends.
*Stay updated on industry regulations, trends, competitor strategies, and market best practices
within Medicare Part D and pharmaceutical coverage.
*Collaborating with internal stakeholders as well as external vendors, including PBM partner
contacts.
*Infrequently support the pricing team on custom group benefit pricings and other ad-hoc
requests.

"This position is eligible to work remotely, hybrid or onsite in accordance with our Telecommuting Policy. Applicants must reside in Kansas or Missouri or be willing to relocate as a condition of employment."

Are you ready to make a difference? Choose to work for one of the most trusted companies in Kansas.

Why Join Us

• Make a Positive Impact: Your work will directly contribute to the health and well-being of Kansans.
• Professional Growth Opportunities: Advance your career with ongoing training and development programs.
• Flexibility: options to work onsite, hybrid or remote available
• upon hire
• Stability: 80 years of commitment, compassion and community
• Inclusive Work Environment: We pride ourselves on fostering a diverse and inclusive workplace where everyone is valued and respected.

What you'll do

• The completion of surveys, special studies related to rating of benefits, and research of historical data.
• Assist with the completion of Schedules/Exhibits for Annual Statement.
• Responsible for testing changes made to systems/databases that affect Actuarial Research.
• The development, maintenance and preparation/reporting of monthly and quarterly reports including, but not limited to:
  
  • Line of Business Report
  • Professional Writeoff Reports
  • Allowed Charges by Type of Provider and Type of Service
• The development and maintenance of models used for calculating the unpaid claims liability. The preparation/reporting of unpaid claims liability. Assist in the monitoring the effectiveness of the unpaid liability estimation model and in developing improvements.
• The development and maintenance of models used for calculating financial projections.
• The preparation/reporting of financial projections. Assist in the monitoring the effectiveness of the projection model and in developing improvements.
• The development and maintenance of models used for calculating enrollment projections. The preparation/reporting of enrollment projections. Assist in the monitoring the effectiveness of the projection model and in developing improvements.
• The development and maintenance of models used for calculating trends. The preparation/reporting of trends. Assist in the monitoring the effectiveness of the trend model and in developing improvements.
• Participate in the preparation of all statewide annual rate filings to the Kansas Insurance Department, as well as related Board exhibits and communication to all areas needing rate information. Ensure compliance with State and Federal laws.
• The development and maintenance of models used for calculating demographic and other factors. The preparation/reporting of demographic and other factors used in the rating of individual and groups as well as for the development of our rate structure. Assist in monitoring the effectiveness of the rate formulas and factors and in the developing improvements.
• The development and maintenance of models used for calculating the Divisible Surplus (Retros) balances for group business. The preparation/reporting of Divisible Surplus (Retros) balances for group business.

What you need

• Bachelor Degree in Mathematics, Actuarial Science, or related
• Six years' experience pricing or reserving health insurance products, either group or individual
• Must have advanced knowledge of actuarial and statistical modeling techniques and how they are applied to solve problems in the health insurance field Must be familiar and have practical.
• Must have advanced knowledge of health insurance individual pricing methodology.
• Must be familiar with health insurance marketing and sales techniques and how they are employed to the different customer segments.
• Intermediate knowledge of a typical health insurance organization's benefit programs and contract language.
• Must be familiar with the laws and regulations of the states the corporation operates in related to actuarial, rating, and underwriting matters.
• Must have and maintain adequate continuing education to be eligible to sign Actuarial Opinion Memorandums relating to health insurance rate filings, according to standards promulgated by the American Academy of Actuaries.

Bonus if you have

• 8 years with at least 1 year of Medicare Advantage and/or Exchange (ACA) RA analytics experience.
• Must have obtained the Fellow designation in the Society of Actuaries and be considered a member in good standing of the American Academy of Actuaries.
• Knowledge of pharmacy technical concepts such as WAC, AWP, AMP, etc.
• Detailed knowledge of the role and mechanisms of PBMs within the healthcare industry.
• Knowledge of health insurance contracts, provider contracts, coding, policies, and procedures.
• Knowledge of the capabilities and limitations of membership, premium, and claims data.
• Knowledge of prospective and retrospective rating procedures and formulas.

Compensation

BCBKS Grade: Exempt 18

Minimum salary: $109,280

Salary determined based on education, skills and experience

Posting Close Date

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