UPMC Health Plan in Pittsburgh, PA seeks multiple Actuarial Leads to apply knowledge of mathematics, probability and statistics to identify issues, gather and analyze data on a wide variety of topics affecting the financial performance of the health plan; assist with reconciling Medicare Advantage Part C and Part D claims data to financials; analyze bid projections of Part B and Part D rebates; evaluate impact of proposed legislative and regulatory changes; develop assumptions, project costs and monitor emerging experience of Medicare Advantage Mandatory Supplemental Benefits including, but not limited to, transportation, vision, healthy foods, fitness and flex card; develop and analyze trend selections of various service categories including inpatient, outpatient, skilled nursing facility, durable medical equipment, Part B, ambulance, lab, physician and home health; assist with providing related party reporting regarding the Medicare Advantage Bid process; develop automation to assist with benefit pricing during the bid process and benefit changes during rebate reallocation leveraging VBA and knowledge with JSON files; perform competitive benchmarking on plan designs, profit margins and administrative expense using financials from statutory filings; respond to requests from CMS bid desk reviewers and other auditors; supervise junior staff, including actuarial analysts, in the completion their projects; assist with setting Premium Deficiency Reserves; supervises an actuarial analyst.

Job Responsibilities: (please list specific job responsibilities)

oApply knowledge of mathematics, probability and statistics to identify issues, gather and analyze data on a wide variety of topics affecting the financial performance of the health plan;

oAssist with reconciling Medicare Advantage Part C and Part D claims data to financials;

oAnalyze bid projections of Part B and Part D rebates;

oEvaluate impact of proposed legislative and regulatory changes;

oDevelop assumptions, project costs and monitor emerging experience of Medicare Advantage Mandatory Supplemental Benefits including, but not limited to, transportation, vision, healthy foods, fitness and flex card;

oDevelop and analyze trend selections of various service categories including inpatient, outpatient, skilled nursing facility, durable medical equipment, Part B, ambulance, lab, physician and home health;

oAssist with providing related party reporting regarding the Medicare Advantage Bid process;

oDevelop automation to assist with benefit pricing during the bid process and benefit changes during rebate reallocation leveraging VBA and knowledge with JSON files;

oPerform competitive benchmarking on plan designs, profit margins and administrative expense using financials from statutory filings;

oRespond to requests from CMS bid desk reviewers and other auditors;

oSupervise junior staff, including actuarial analysts, in the completion their projects;

oAssist with setting Premium Deficiency Reserves; and

oSupervises an actuarial analyst.

Qualifications:

• Master's degree, or equivalent, in Actuarial Science, Mathematics, Statistics, Economics, or related field plus two (2) years of actuarial experience in health insurance/managed care, actuarial consulting to health actuaries, or related experience:
• valuating and pricing Medicare (Part C and Part D);
• building financial risk models from start to finish;
• working with CMS BPTs (both Part C and Part D) and required reporting elements such as CMS MLR;
• responding to and providing quantitative support for CMS for bid desk review, financial audit, and full bid audit;
• developing risk scores, employing different risk models;
• managing or training junior staff; utilizing tools and technologies including: SQL or SAS, Excel including VBA, macro development, data retrieval, and Power BI.
• Must hold ASA or FSA certification by Society of Actuaries.
• Telecommuting permissible.