Full-time
Description
Reporting directly to the SVP and Chief Actuary at ConcertoCare, the Sr. Actuarial Director will be responsible for a variety of exciting actuarial analytics at a fast-growing company. The person in this role will have the opportunity to design analytics and provide actuarial insights to the company's executive team on several key areas including medical expense and revenue analysis, evaluation of our clinical models, financial forecasting, and pricing new partnerships. In each of these areas the Actuarial Director will be instrumental in guiding current and future business initiatives as ConcertoCare broadens in scope. The actuary in this role may also direct the work of other actuarial analysts as the team expands.
ESSENTIAL DUTIES AND RESPONSIBILITIES
Medical Expense Reporting:
- Design and perform actuarial studies and reports related to medical costs, risk scores, revenue, and membership; present strong visuals and key insights to executive leadership
- Analyze results to identify early signs of adverse trends or other issues related to medical care costs and premium based revenue
- Work in collaboration with senior management and IT to optimize purchased solutions for performance analytics and medical economics
Performance Measurement:
- Create analytics and reporting on existing and new programs such as Direct Contracting and PACE
- Design and perform studies on the value of existing and potential interventions and clinical programs - both to optimize our clinical models, as well as for use in marketing materials
- Enhance predictive analytics and proprietary clinical algorithm to optimize outcomes
Financial Forecasting:
- Perform the monthly reserve-setting process applying both modeling and judgment
- Inform the quarterly financial forecast with actuarially-sound inputs
- Quantify and highlight drivers of variance to the financial plan by line of business
Pricing and Underwriting:
- Represent Finance in business development discussions, contributing strong recommendations on how to best structure risk-sharing arrangements through a combination of historic and predictive analytics
- Set and update pricing structures and financial guardrails for each line of business, leveraging emerging experience and actuarial judgment
Capabilities:
- Apply a healthy balance of creative thinking and actuarial discipline in the development of core actuarial processes and analytics
- Actively engage with the ConcertoCare leadership team in setting the strategic direction of the company
- Identify overall drivers of emerging results and communicate clearly and succinctly to a non-technical audience
- Develop and maintain strong working relationships with key stakeholders including market leadership, physician and clinical operations leadership, IT, the revenue optimization team, and finance peers
- Ready to build new tools and capabilities in a new organization; show great initiative combined with the knowledge of when to ask for guidance
- Manage several fast-paced projects with an ability to produce quality materials within tight timeframes
- Integrate actuarial industry standards and external trend information to help ConcertoCare develop prospective and target performance levels
Requirements:
- Associate or Fellow of the Society of Actuaries
- Bachelor's Degree in Actuarial Studies, Statistics, or related field preferred
- Minimum eight years' experience in healthcare field with a strong understanding of health insurance product design (ideally Medicare and Medicaid), medical expense analysis, reserving/forecasting, medical coding, and risk score optimization
- Experience in Government health care contracts preferred (Medicare and Medicaid)
- Proficient in Excel, Microsoft Office, SQL, SAS or other coding language
We are an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or veteran status.
ConcertoCare is an Alcohol/Drug/Smoke-Free Workplace
Base Salary/ Wage Range $200,000 to $226,000 with annual bonus. Compensation for the role is commensurate with the candidate's qualifications, skills, competencies, and experience and may fall outside of the range shown. ConcertoCare offers a competitive total rewards package, which includes full healthcare coverage, a 401K with match, and a broad range of other health, wellness, and financial benefits.