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Actuary Lead- Value Based Contracting

4 months ago

Pittsburgh, United States tapwage Full time

UPMC Health Plan has an exciting opportunity for an Actuary Lead on their rockstar Value-Based Contracting Team

This position applies knowledge of mathematics, probability, and statistics in order to identify issues and gather and analyze data on a wide variety of topics affecting the financial performance of the health plan. Ensure timely and accurate services to clients. Supports strong internal and external relationships.

Preferences:

- Working experience in SQL and Excel
- Experience following fields: value-based contracting, pricing, reserving, trend/health economics, provider network analysis, risk adjustment, etc
- FSA or ASA

This role can be remote anywhere within the US

Responsibilities:

- Presents results of analyses and recommendations to actuarial management.
- Develop junior actuarial department staff
- Support the Medicare Bid process, including preparing presentations, providing all requested reports and pricing, responding to desk review queries, and working with other departments to file all bids in a timely manner
- Responsible for the preparation of financial analyses in support of the following functions: Medical cost and utilization trend analysis; Forecasting; - Provide analytical support for rate development and filings; - Provide ad hoc data analysis to all departments within the company.
- Documents methods, procedures and results.
- Provide actuarial support and requests for the annual CMS Financial Audits; communicate with auditors when needed
- Will direct junior actuarial department personnel in the performance of duties.
- Price, analyze, and assign annual premium increases/decreases to Medicare Employer Groups; includes communication with product development/ sales and the ability to explain pricing decisions to senior management
- Review of other's work product.
- Prepares and reviews Medicare Bid Submissions.
- Responsible for the development of mathematical models in connection with other departments to predict the impact of proposed changes.
- Will own project management of projects, including deliverables and appropriate work.
- Bachelor's degree in mathematics, statistics, actuarial science, economics, or related field
- Five plus years of experience in actuarial work in health insurance, managed care or related consulting business; or equivalent training, education, and/or experience.
- Excellent problem-solving and analytical skills.
- In-depth understanding of health insurance market dynamics.
- ASA certification at minimum

Licensure, Certifications, and Clearances:

ASA certification, min

- Act 34
- UPMC is an Equal Opportunity Employer/Disability/Veteran