UPMC Health Plan's Medicaid/Government Product actuary team is seeking a Senior Manager to lead the department's Behavioral Health support! This role ensures that the Actuarial Department provides excellent services to various internal and external clients in the areas of pricing, reserving, forecasting, benefits, and product development, provider relations/contracting, underwriting, and compliance. Responsible for supervising actuarial analysts. Responsible for state and federal filings including actuarial certification. This role also presents to the senior financial leadership team.
This role can be remote within the continental US. If you have expertise in behavioral health and/or Medicaid managed care pricing and support, have an ASA or FSA, 7+ years of actuarial experience, APPLY TODAY!
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Responsibilities:
- Support the BH pricing process including engaging in advocacy with the state and its actuaries and completing all needed pricing work and trend analysis.
- Support the development of monthly claim reserves for behavioral health contracts.
- Complete internal and external facing actuarial reporting including communication with external stakeholders related to the 12 active contracts.
- Forecasting: To provide UPMC HP senior management and other partners with regular and ad hoc reports which communicate current and future near- and long-term projections of financial performance of the various health product lines to facilitate corporate decision and the development of corporate strategies and goals.
- Work on RFP support when county contracts are up for re-procurement.
- Provide an effective level of visibility into financial results to support analysis, reporting, and business outcomes.
- Continuously improve valuation models to incorporate the latest data and actuarial and statistical approaches.
- Assist in the development and filing of Statement of Actuarial Opinions and associated Memoranda.
- Ensure development of robust controls to support financial and regulatory audits.
- Benefits Valuations: To provide appropriate UPMC management personnel with actuarial valuations of the Impact of any proposed benefit changes on an as-needed basis.
- Provider Relations/contracting: To 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.
- Consultant within UPMC Health System; Act as an Actuarial Consultant within the UPMC Health System and perform various activities, Including IBNR calculations, Data Analysis.
- Assist in building out insurance risk management.
- Ability to solve issues with a sense of urgency.
Qualifications:
- Associate or Fellow in the Society of Actuaries and
- 7+ years of relevant actuarial experience and a valuation background within the insurance industry required.
- Expertise in Behavioral health and/or Medicaid managed care pricing and support
- Must have a comprehensive knowledge of actuarial principles, the Affordable Care Act, Medicare Advantage, and financial and regulatory reporting requirements
- Demonstrated ability to navigate ambiguity to drive to outcomes, work with large datasets and distill analyses into actionable business insights
- Collaborative attitude to work in highly cross-functional organizations
- Experience in SQL or Python is a plus
Licensure, Certifications, and Clearances: - Act 34
UPMC is an Equal Opportunity Employer/Disability/Veteran
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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.