Actuarial Risk Adjustment Specialist

1 week ago

Boise, Idaho, United States PacificSource Administrators, Inc. Full time
Actuarial Risk Adjustment Specialist page is loaded
Actuarial Risk Adjustment Specialist

Actuarial Risk Adjustment Specialist
locationsBoise, ID

time typeFull time

posted onPosted 6 Days Ago

job requisition id

*Join PacificSource and help our members access quality, affordable care*
PacificSource is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to status as a protected veteran or a qualified individual with a disability, or other protected status, such as race, religion, color, national origin, sex, sexual orientation, gender identity or age.

Diversity and Inclusion: PacificSource values the diversity of the people we hire and serve. We are committed to creating a diverse environment and fostering a workplace in which individual differences are appreciated, respected and responded to in ways that fully develop and utilize each persons talents and strengths.
Job Description
Provide actuarial and data analytic services related to health status based risk adjustment. Responsible for accurate and reliable actuarial activities.

Ensure sound data extraction, data analysis, and actuarial analysis of healthcare risk, resulting in the attainment of PacificSource's financial and enrollment goals.

Provide documented input on decisions which impact the risk assumed through various current or proposed activities.

Essential responsibilities:

  • Accurately apply CMS SAS packages for calculation and projection of HHS-HCC Plan Liability Risk Scores. Work with changing data specifications and code packages.
  • Stay apprised of CMS regulations, announcements, and updates impacting the HHS-operated risk adjustment program. Measure predicted impact of changes to HHS-HCC risk model and transfer formula, and determine appropriate adjustments to pricing assumptions.
  • Responsible for timely and accurate data extraction and submission of risk adjustment-related data to consulting actuarial firms. Responsible for error checking, collaborative error resolution, and overall reasonability checking consultant results.
  • Act as an intermediary with Actuarial, IT, Risk Assessment, consulting actuarial firms, and other stakeholders as required to ensure internal consistency and accuracy of risk adjustment data and calculations.
  • Analyze claims, enrollment, premium, market trends, consultant results and other factors needed to determine appropriate assumptions of risk transfer formula elements. Recommend monthly estimates of commercial risk transfer amounts.
  • Model and recommend year end estimates of commercial risk adjustment transfer amounts for use in Annual Statement. Prepare supporting memoranda and respond to auditor inquiries.
  • Model and recommend pricing assumptions related commercial risk adjustment for use in rate filings.
  • Provide actuarial support for ad hoc requests related to risk classification and risk adjustment for all lines of business.

Requirements*:
**Bachelor's degree or the foreign degree equivalent in Mathematics, Statistics, Actuarial Science, or a related field.

In addition, two (2) years of experience in the job offered or a related role and must possess the following:

  • At least two (2) years of health actuarial experience
  • At least two (2) years of SAS or SQL experience
  • At least two (2) years of MS Excel experience
  • Has passed a minimum of 5 Society of Actuaries actuarial exams (or with the fifth exam to be completed within 2 years of onboarding)

Location:
Boise, ID Apply at:

Our Values
We live and breathe our values.

In fact, our culture is driven by these seven core values which guide us in how we do business:

  • We are committed to doing the right thing.
  • We are one team working toward a common goal.
  • We are each responsible for customer service.
  • We practice open communication at all levels of the company to foster individual, team and company growth.
  • We actively participate in efforts to improve our many communities-internally
and externally.

  • We actively work to advance social justice, equity, diversity and inclusion in our workplace, the healthcare system and community.
  • We encourage creativity, innovation, and the pursuit of excellence.

Physical Requirements:

Stoop and bend. Sit and/or stand for extended periods of time while performing core job functions. Repetitive

motions to include typing, sorting and filing. Light lifting and carrying of files and business materials. Ability to read and comprehend both written and spoken English. Communicate clearly and effectively.

Disclaimer:


This job description indicates the general nature and level of work performed by employees within this position and is subject to change.

It is not designed to contain or be interpreted as a comprehensive list of all duties, responsibilities, and qualifications required of employees assigned to this position.

Employment remains AT-WILL at all times.
locationBoise, ID

time typeFull time

posted onPosted 28 Days Ago

PacificSource is anything but a typical health insurance company.

Founded in 1933, were an independent, not-for-profit organization that puts our members, and their communities firstacross Idaho, Oregon, Montana, and Washington.

It's our 1,600+ employees who make it happen: promoting health equity and partnering with providers to deliver better access to optimal, affordable care.

*So yes*, with PacificSource, you get to do great things.

In our effort to put members firstmore than 500,000 of theminitiative, commitment, and hard work are supported and rewarded with excellent benefits, competitive wages, and opportunities for personal growth and advancement.


Benefits:


Medical, vision, and dental insurance, incentive program, paid time off and holidays, 401(k) plan, flexible telecommute policy, volunteer opportunities, tuition reimbursement and training, life insurance, and options such as a flexible spending account.

We love our common purpose. Empowerment, flexibility, and sharing success make for a great place to work.

Heres what else we feel good about:

  • A mission with a real sense of shared values
  • Competitive wages and outstanding benefits, including telecommuting
  • Opportunities for learning development and career advancement
  • Organizational leadership style rooted in servant and transformational leadership
  • A commitment to support the communities we serve
  • A belief in the importance of work-life balance
PacificSource is an equal opportunity employer and a company that loves helping people.

We work with our employees to understand their goals, and provide training, individual development, and career advancement opportunities to help them achieve just that.

In the past nine months alone, we have had 210 internal promotions. That means 32% of our open positions have been sourced internally.

#J-18808-Ljbffr

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