This position will perform actuarial analyses for Commercial, Medicaid and Medicare business including, but not limited to medical expense analyses and projections, determining rates and preparing supporting documentation for rate filings with DOI, pharmacy analytics and projections, building and maintaining rate models, analyzing data in support of monthly reserve process, and ad hoc actuarial analyses. In addition, this position will work closely with the legal department to identify size and communicate financial risks and opportunities related to legislative and regulatory changes including impacts to premiums, benefits and product designs.
Accountabilities
- Provide data and support for the development of rate filings for submission to the Department of Insurance, includes support documentation
- Provide data and support for the development of Medicare Advantage bids for submission. Includes support documentation
- Closely monitors and assesses competitors' rates, trends and rating methodologies
- Supports various initiatives as needed by actuarial modeling
- Develops/enhances ad hoc reports to assist in actuarial analyses of emerging results
- Creates and maintains large databases of information utilizing a unique skill set of spreadsheet and relational database abilities
- Provides analysis of inpatient facility, outpatient facility and professional claims experience, measures utilization levels and trends, evaluates cost and intensity levels and trends, and performs various other actuarial and mathematical analyses
- Provides analysis of drug claims experience, measures utilization levels and trends, evaluates cost and intensity levels and trends, and performs various other actuarial and mathematical analyses Develop data and reports in support of reinsurance, risk adjustment and risk corridors, ensuring accurate impacts in pricing and coordination with rebate determination
- Drill into medical expense problem areas, and provide results to Medical Management and Network Operations in order to determine implement and monitor solutions
- Develops/enhances ad hoc reports to assist in financial analysis of operating results and support for actuarial analyses key to understanding financial position
- Assess the financial or pricing impact of variations in benefits and provider contracts Update and analyze the monthly reserve (IBNR) model for all lines of business Responsible for Medicaid rate reconciliations as needed
- Assist with audit requests as needed
- Estimate mandated benefit cost and calculate pricing of non-standard benefits and requested riders
- Perform other related projects and duties as assigned
Education / Experience / Other Information (include only those that are specific to the role)
Bachelor's Degree required, preferably in Actuarial Science/Mathematics/Finance/Healthcare Management or a related field or combination of years of related experience and number of actuarial exams passed equal or exceeds 2. Ex: 2 years of actuarial experience or 2 passed actuarial exams.
- Demonstration of previous work experience is required.
- Excellent quantitative, problem solving and analytical skills.
- Strong communication skills.
- Technical skills with database concepts, data analysis development, data warehousing and decision support tools.
- Knowledge of MS-Office products, particularly MS-Access and Excel are required. Familiarity with SAS or SQL required.