This position applies knowledge of mathematics, probability, and statistics in order to identify issues and gather and analyze data on a wide variety of topics affecting the financial performance of the health plan. Ensure timely and accurate services to clients. Supports strong internal and external relationships.
Preferences:
- Working experience in SQL and Excel
- Experience following fields: value-based contracting, pricing, reserving, trend/health economics, provider network analysis, risk adjustment, etc
- FSA or ASA
This role can be remote anywhere within the US!
Responsibilities:
- Presents results of analyses and recommendations to actuarial management.
- Develop junior actuarial department staff
- Support the Medicare Bid process, including preparing presentations, providing all requested reports and pricing, responding to desk review queries, and working with other departments to file all bids in a timely manner
- Responsible for the preparation of financial analyses in support of the following functions: Medical cost and utilization trend analysis; Forecasting; - Provide analytical support for rate development and filings; - Provide ad hoc data analysis to all departments within the company.
- Documents methods, procedures and results.
- Provide actuarial support and requests for the annual CMS Financial Audits; communicate with auditors when needed
- Will direct junior actuarial department personnel in the performance of duties.
- Price, analyze, and assign annual premium increases/decreases to Medicare Employer Groups; includes communication with product development/ sales and the ability to explain pricing decisions to senior management
- Review of other's work product.
- Prepares and reviews Medicare Bid Submissions.
- Responsible for the development of mathematical models in connection with other departments to predict the impact of proposed changes.
- Will own project management of projects, including deliverables and appropriate work.
Qualifications:
- Bachelor's degree in mathematics, statistics, actuarial science, economics, or related field
- Five plus years of experience in actuarial work in health insurance, managed care or related consulting business; or equivalent training, education, and/or experience.
- Excellent problem-solving and analytical skills.
- In-depth understanding of health insurance market dynamics.
- ASA certification at minimum
Licensure, Certifications, and Clearances:
ASA certification, min
- Act 34
- UPMC is an Equal Opportunity Employer/Disability/Veteran
Working at
UPMC Senior Communities
UPMC Senior Communities is a reputable and leading provider of senior living and healthcare services. With a strong commitment to exceptional care, UPMC Senior Communities offers a range of options including independent living, assisted living, and memory care. As an actuary at UPMC Senior Communities, you'll be part of a dedicated team that plays a crucial role in managing risks and ensuring the financial stability of the organization. Actuaries utilize their expertise in statistical modeling, data analysis, and risk assessment to evaluate risks, develop pricing strategies, and provide insights that support evidence-based decision-making. Collaborating with cross-functional teams, actuaries at UPMC Senior Communities contribute their analytical skills to optimize financial resources, forecast trends, and develop strategies that enhance the financial health of the organization. Actuaries analyze complex data sets, assess risks, and provide recommendations that help in providing quality care to seniors while maintaining a sustainable financial model. UPMC Senior Communities values professional growth and offers ongoing training and development opportunities for actuaries. Actuaries have the chance to enhance their skills, stay up to date with industry advancements, and contribute to the success of providing exceptional care to seniors. Join UPMC Senior Communities' esteemed actuarial team and embark on a rewarding career where you can apply your actuarial expertise, make a meaningful impact on the lives of seniors, and enjoy competitive benefits in a supportive and compassionate work environment.