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Sr. Director, Risk Adjustment Modeling Analytics & Submission

Horizon Blue Cross Blue Shield of New Jersey

Closed
Health/Insurer/Director Level

Sr. Director, Risk Adjustment Modeling Analytics & Submission

Horizon Blue Cross Blue Shield of New Jersey

Hopewell, NJ - Remote · Remote · 10mo ago

Closed
Salary
$191k - $266k
Experience
10+ Years

Role Summary

Senior Health actuary (Sr. Director) leading risk adjustment analytics, predictive modeling, and encounter submission platforms for Commercial, Medicare Advantage, Medicaid and ACA lines. Responsible for end-to-end data, model development, regulatory submissions, and signing actuarial filings. Senior leadership role reporting to the VP of Medical Economics and Risk Adjustment. Remote role with required residence in certain Northeastern US states.

Key Requirements

  • Fellow of the Society of Actuaries (FSA) required
  • Minimum 10 years in healthcare/health insurance or insurance analytics
  • At least 7 years supervising data scientists and actuaries
  • Bachelor’s degree in math, statistics, actuarial science, or related field
  • Hands-on experience with clinical and claims data and SAS, R, and SQL

Skills & Domain

ToolsExcelPowerPoint
DomainPricing, analytics, and modeling for ACA, Medicare Advantage, and MedicaidSupervisory experience managing data scientists and actuaries (7+ years)Experience with clinical and claims data analytics and encounter submissionsExperience producing and signing actuarial forecasts, valuations, and filings