This person ensures that the Actuarial Department provides excellent services to various internal and external clients in the areas of provider relations, contracting and forecasting. Responsible for supervising actuarial analysts. Presents to senior financial leadership. Participates in the design and negotiation of new value-based contracts.
The candidate selected for this position can work remotely within the continental United States.
Preferences: Value-based contracting, commercial pricing, Medicare pricing, reserving, medical economics, commercial, Medicaid or Medicare risk adjustment, or Financial forecasting and Analysis.
Responsibilities:
- Determine the performance measures, associated benchmarks, and other contractual components to include in new-formed value-based contracts. Assures reliability of measures and statistical methodologies in tracking performance.
- Provide reports for the purpose of evaluating and advising UPMC HP management on the financial impact of proposed provider agreements or changes to existing agreements on an as-needed basis.
- Analyze Fee For Service arrangements, contract changes, and project future unit cost trends. Calculate values of network relativity factors used in rating and underwriting. Evaluate and model alternative payment models (e.g. per diem vs DRG, bundled payments, case rates).
- Provide expertise to Contracting and Network services areas in rate modeling and fee schedule preparation, training, process development, etc.
- Create and analyze ACO contracts, PCMH arrangements, Global Capitation, Bundled Rates, Episodic Payments, Capitation, Risk Adjusted Total Cost of Care, and Value Based Payments. Review risk/shared savings payouts and accruals.
- Ability to learn new lines of business to help UPMC Health Systems to expand into different arenas such as Stop Loss Insurance or Workers Compensation.
- Work closely with Enterprise Risk Management and key internal stakeholders to build and enhance insurance (underwriting and reserving) risk assessment, monitor changes to the risk profile, risk analytics, and understand key drivers.
- Consultant within UPMC Health System; Act as an Actuarial Consultant within the UPMC Health System and perform various activities, including IBNR calculations and Data Analysis.
- Ability to solve issues with a sense of urgency.
- Performs in accordance with system-wide competencies/behaviors.
- Performs other duties as assigned.
Qualifications:
- Bachelor's degree in mathematics, statistics, actuarial science, economics, or a related field is required.
- Advanced degree preferred.
- 6.5 years of experience in progressively more responsible actuarial work in health insurance/managed care or equivalent training/education.
- Experience with commercial and government health programs preferred.
- In-depth understanding of health insurance market dynamics.
- Excellent problem-solving and analytical skills.
- Good oral and written communication skills.
- Strong PC skills.
- Data retrieval skills and relational database experience.
- Management experience preferred.
Licensure, Certifications, and Clearances:
Licensure/Certification: ASA or FSA certification by Society of Actuaries required.Membership in the American Academy of Actuaries required.
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.