Senior Manager, Actuary- Behavioral Health

Found in: beBee S US - 3 weeks ago

Pittsburgh, United States UPMC Senior Communities Full time
We are UPMC, and we are changing health care for the better. With 96,000 employees, 40 hospitals, 800 doctors' offices and outpatient sites, and a more than 4-million-member Insurance Services Division, we all have one mission: to provide Life Changing Medicine, every day. Whoever you are and whatever you'd like to do, UPMC has a place for you.

UPMC Health Plan's Medicaid/Government Product actuary team is seeking a Senior Manager to lead the department's Behavioral Health support This role ensures that the Actuarial Department provides excellent services to various internal and external clients in the areas of pricing, reserving, forecasting, benefits, and product development, provider relations/contracting, underwriting, and compliance. Responsible for supervising actuarial analysts. Responsible for state and federal filings including actuarial certification. This role also presents to the senior financial leadership team.

This role can be remote within the continental US. If you have expertise in behavioral health and/or Medicaid managed care pricing and support, have an ASA or FSA, 7+ years of actuarial experience, APPLY TODAY

UPMC is being recognized as one of the best places to work in the country

UPMC is among the healthiest places to work in the country

Responsibilities:
  • Support the BH pricing process including engaging in advocacy with the state and its actuaries and completing all needed pricing work and trend analysis.
  • Support the development of monthly claim reserves for behavioral health contracts.
  • Complete internal and external facing actuarial reporting including communication with external stakeholders related to the 12 active contracts.
  • Forecasting: To provide UPMC HP senior management and other partners with regular and ad hoc reports which communicate current and future near- and long-term projections of financial performance of the various health product lines to facilitate corporate decision and the development of corporate strategies and goals.
  • Work on RFP support when county contracts are up for re-procurement.
  • Provide an effective level of visibility into financial results to support analysis, reporting, and business outcomes.
  • Continuously improve valuation models to incorporate the latest data and actuarial and statistical approaches.
  • Assist in the development and filing of Statement of Actuarial Opinions and associated Memoranda.
  • Ensure development of robust controls to support financial and regulatory audits.
  • Benefits Valuations: To provide appropriate UPMC management personnel with actuarial valuations of the Impact of any proposed benefit changes on an as-needed basis.
  • Provider Relations/contracting: To provide reports for the purpose of evaluating and advising UPMC HP management on the financial impact of proposed provider agreements or changes to existing agreements on an as-needed basis.
  • Consultant within UPMC Health System; Act as an Actuarial Consultant within the UPMC Health System and perform various activities, Including IBNR calculations, Data Analysis.
  • Assist in building out insurance risk management.
  • Ability to solve issues with a sense of urgency.


Qualifications:

  • Associate or Fellow in the Society of Actuaries and
    • 7+ years of relevant actuarial experience and a valuation background within the insurance industry required.
  • Expertise in Behavioral health and/or Medicaid managed care pricing and support
  • Must have a comprehensive knowledge of actuarial principles, the Affordable Care Act, Medicare Advantage, and financial and regulatory reporting requirements
  • Demonstrated ability to navigate ambiguity to drive to outcomes, work with large datasets and distill analyses into actionable business insights
  • Collaborative attitude to work in highly cross-functional organizations
  • Experience in SQL or Python is a plus
    Licensure, Certifications, and Clearances:
  • Act 34

UPMC is an Equal Opportunity Employer/Disability/Veteran

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