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Actuarial Analyst II

1 month ago

Norfolk, Virginia, United States Sentara Healthcare Full time
Job Summary

This role will be within an Actuarial department, focusing on Risk Adjustment and predictive analytics. Opportunities to rotate to other areas within the department will be available after a minimum of two years' satisfactory performance in risk adjustment. Actuarial student program provided.

Key Responsibilities:
  • Create models that identify and predict diseases in our members.
  • Generate forecasts of risk adjusted revenues for year-end accruals.
  • Maintain data structures that house HCC models and member data.
  • Measure key metrics related to point-of-care gap closure solutions.
  • Valuate the financial impact of risk-adjustment operations.
  • Assist in ad-hoc requests related to risk scores and revenue.
  • Advise on the strategic considerations of risk-adjustment activities.
  • Develop new processes that improve on the department's objectives.
Requirements:

Minimum 2 years in Actuarial Analysis. Analytical and problem-solving skills are necessary; ability to work under tight deadlines and handle pressure situations; ability to work in a team environment. Minimum completion of three Actuarial exams with continued progress towards Society of Actuaries credential. Experience in at least 3 of the following areas:
  • IBNR and reserve setting
  • General pricing and filing support of Individual products
  • General pricing and filing support of Small Group products
  • General pricing and filing support of Large Group products
  • Assist in Medicare Advantage Bid filing
  • Evaluation of Managed Medicaid programs
  • Provider Contract evaluations
  • Provider Profit/withhold settlement evaluations
  • Product Experience Monitoring
  • Reinsurance/Stop-loss Reporting
Benefits:

Sentara employees strive to make our communities healthier places to live. We're setting the standard for medical excellence within a vibrant, creative, and highly productive workplace. For more information about our employee benefits, https://www.sentaracareers.com/explore-sentara/benefits/

Qualifications:

BLD - Bachelor's Level Degree (Required)

Skills

Sentara Healthcare prides itself on the diversity and inclusiveness of its close to an almost 30,000-member workforce. Diversity, inclusion, and belonging is a guiding principle of the organization to ensure its workforce reflects the communities it serves.

Per Clinical Laboratory Improvement Amendments (CLIA), some clinical environments require proof of education; these regulations are posted at ecfr.gov for further information. In an effort to expedite this verification requirement, we encourage you to upload your diploma or transcript at time of application.

In support of our mission \"to improve health every day,\" this is a tobacco-free environment.