Actuary

2 weeks ago

Des Moines, United States Wellmark, Inc. Full time
Company Description

Why Wellmark: We are a mutual insurance company owned by our policy holders across Iowa and South Dakota, and we've built our reputation on over 80 years' worth of trust. We are not motivated by profits. We are motivated by the well-being of our friends, family, and neighbors-our members. If you're passionate about joining an organization working hard to put its members first, to provide best-in-class service, and one that is committed to sustainability and innovation, consider applying today

Learn more about our unique benefit offerings here.

You can also learn more about working at Wellmark here.

Job Description

As an Actuary, you will support business strategies related to financial risk for your assigned market segments. Evaluate financial risk and competitiveness associated with provider networks, premium rate setting, risk adjustment methodologies, exchanges (public and private), new technology, legislative and regulatory changes, utilization management programs, and other market forces. Determine forecasts and trends as appropriate. Build and maintain relationships with key customers and strategic partners.

Qualifications

Required:
  • Bachelor's Degree in Actuarial Science or related field, or direct and applicable work experience
  • Associate of the Society of Actuaries (ASA)
  • Minimum 4 years of experience in an actuarial role within health insurance
  • Thorough knowledge of at least one computer language, such as R, SAS or SQL
  • Advanced leading subject matter expert in two or more of pricing, reserving, or predictive modeling or other technical actuarial area: catastrophe model, economic capital model or assumed reinsurance with excellent knowledge of statistics and probability
  • Proven ability to organize and analyze data, develop predictive models to drive business decisions, interpret the model results, turn data into actionable insights, and effectively communicate model results
  • Excellent verbal and written communication and presentation skills, with the ability to effectively communicate to varying audiences
  • Strong consultation and interpersonal skills, with the ability to build relationships and collaborate across the business to produce results
  • Ability to independently manage projects and make decisions in a deadline driven, fast-paced environment
  • Proven ability to understating of applicable rules and regulations
  • Ability to coach and mentor others. Ability to effectively lead a team
  • Proficiency with Microsoft Suite and technical aptitude to learn new systems quickly and produce ad hoc reports. Advanced knowledge of Excel, PowerPoint and PowerBI and Word


Preferred:
  • Bachelor's Degree in Actuarial Science or a related field
  • Ability to facilitate presentations to varying audiences, including key decision makers
  • Ability to identify creative, innovative solutions that help support and achieve long-range strategic goals
  • Pharmacy experience, such as evaluating PBM contracts, analyzing Pharmacy discounts/rebates, or determining client-specific Pharmacy financial guarantees.


Additional Information

a. Provide analysis and recommendations in order for assigned market segment(s) to achieve corporate profitability objectives, by initiating analyses based on review of the market segment(s) that are both assigned and initiated.

b. Provide dependable, accurate and timely information regarding rates, trends, rating factors and formulas to support internal stakeholder functions (e.g. Underwriting, Product Development). Provide information relating to regulations and rules. Consult on various issues related to rating of specific groups or benefits.

c. Develop rates, rating factors and rate filings. Develop and maintain rating methods and models. Develop and maintain sound liability estimation methodologies.

d. Initiate comprehensive and timely data analysis of health care trends and financial measures with summary conclusions. Collaborate and partner with Business Analytics staff regarding data analysis for assigned work.

e. Maintain, forecast, and provide oversight for needed rate increases by assigned market segments. Use data collection and research methodologies that meet established actuarial guidelines for statistical accuracy and that will produce reasonable results.

f. Perform peer review activities including reviewing data, formulas and calculations as needed to validate work products completed by others. Reviewer should also be able to sign off and certify that work is in accordance with standard actuarial principles and is in accordance with any regulatory guidelines.

g. Calculate adequate unpaid claims liabilities, with direction, as assigned. Provide information as needed for financial reporting (e.g. reserves, annual statement exhibits).

h. Provide technical input on changes to existing and new regulation rules; including recommendations that contribute to top-level decision-making regarding products, pricing, financial performance, distribution, regulatory compliance, and legislative issues. Interpret rating regulations.

i. Provide information to internal stakeholders in the areas of trends and rating decisions to aid in sales and retention and impact of provider contracts on pricing and experience by product.

j. Consult with various departments such as Rating & Underwriting, Healthcare Informatics, Network Management, Product Development, Provider Contracting, Corporate Communications, Financial Reporting, Compliance and others as needed on various initiatives.

k. Prepare and maintain documentation related to standard operating procedures as well as routine and special projects.

l. Serve as a subject matter resource for corporate or departmental process improvement initiatives, involving designing, adjusting, and documenting work processes workflow to ensure that predictable and replicable success is achieved through best practice. Adopt a whole system view in evaluating and improving the sequence and content of work activities to optimize process effectiveness and integrity.

m. Provide benefit cost information for various legislative initiatives. Provide technical input on changes to new and existing regulations and rules. Interpret how regulatory and legislative changes may affect business and develop impact analyses.

n. Other duties as assigned.

An Equal Opportunity Employer

The policy of Wellmark Blue Cross Blue Shield is to recruit, hire, train and promote individuals in all job classifications without regard to race, color, religion, sex, national origin, age, veteran status, disability, sexual orientation, gender identity or any other characteristic protected by law.

Applicants requiring a reasonable accommodation due to a disability at any stage of the employment application process should contact us at careers@wellmark.com

Please inform us if you meet the definition of a "Covered DoD official".

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