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Actuarial Manager, Reserves

2 months ago

Plantation, United States Pediatric Associates Full time
Remote Opportunity

PRIMARY FUNCTION

The Actuarial Manager, Reserves is responsible for establishing the monthly accruals related to risk-based contracts. This role will require collaboration with cross-functional teams, including accounting, FP&A, managed care, clinical, and operations, to reconcile interim and final settlements to reserves with financial statements, provide insights into variances and trends, and consider the value of clinical initiatives on the outstanding reserve.

ESSENTIAL DUTIES AND RESPONSIBILITIES

This list may not include all of the duties that may be assigned.
  1. Oversees the monthly accrual process, ensuring timely and accurate estimation of surplus/deficits related to risk contracts.
  2. Collaborates with cross-functional teams, including accounting, FP&A, managed care, clinical, and operations, to reconcile IBNR reserves with financial statements, provide insights into variances and trends, and consider the value of clinical initiatives on the outstanding IBNR.
  3. The role will support the development of a reserving methodology, documentation and data validation controls.
  4. Partnering with Finance on financial reporting matters and audit requests.
  5. Supports reviewing the payor's estimated contract balance against accrued balances and provide data-backed findings to the Managed Care team, while considering the contract settlement terms.
  6. Monitors the sufficiency of reserves, the development of reserve ranges, and supporting recommendations on provisions for adverse deviations.
  7. This role will involve moderately complex to complex issues where the analysis of situations requires in-depth data analysis and consideration of variable factors. Critical skills for this role will be possessing the ability to perform data analysis and communicating the impact on the contract balances.
  8. This role will require being flexible and a collaborative business partner in a growing organization.


SUPERVISORY RESPONSIBILITIES

Oversee the value-based care reserving function at Pediatric Associates.

QUALIFICATIONS

EDUCATION: Bachelor's degree in Actuarial Science, Finance, Healthcare Administration or other related field.

EXPERIENCE:
  • 7 or more years of healthcare actuarial work experience required.
  • 3 years of experience in a health insurance reserving capacity.
  • Experience in establishing provider contract reserves and monitoring of settlements.
  • Experience in Managed Medicaid.

LICENSURE / CERTIFICATION
  • ASA or FSA designation
  • Member of the American Academy of Actuaries

KNOWLEDGE, SKILLS AND ABILITIES
  • Skills to develop and maintain actuarial models to evaluate financial performance, risk, and opportunities associated with value-cased care arrangements.
  • Strong proficiency in actuarial modeling software and statistical analysis tools (e.g. Excel, SQL, SAS, R, Python)
  • Strong communication skills, including using exhibits and presentations to translate technical issues for non-actuarial audiences.
  • In-depth understanding of medical economics principles, including healthcare cost analysis, reimbursement methodologies, risk stratification and financial performance metrics.
  • Experience in conducting medical cost trend analysis, utilization review, and forecasting to support strategic decision-making.
  • Ability to think holistically through a project

TYPICAL WORKING CONDITIONS
  • Non-patient facing
  • May rotate working in the office and remote.
  • Must be U.S. based.


OTHER PHYSICAL REQUIREMENTS
  • Vision
  • Sense of sound
  • Sense of touch

PERFORMANCE REQUIREMENTS

Adhere to all organizational information security policies and protect all sensitive information including but not limited to ePHI and PHI (Protected Health Information) in accordance with organizational policy, Federal, State, and local regulations.