Overview Director - Actuarial Healthcare Analytics - Payor Contracting
- Full-Time, 40 hours per week.
- Monday - Friday; Hours will vary.
- Downers Grove, IL
Deliver effective analytics with actionable insights to achieve best in class fee for service and value based care contract performance
Responsibilities- Own the process of monitoring performance in payer contracts across Duly geographies and all lines of business including budget and IBNR setting (20%)
- Conduct analysis, including benchmark and trend/performance forecasts, to inform decisions on payer participation, reduce medical costs across our markets and measuring the impact of proposed contracts or interventions (20%)
- Independently accountable for generating analytical insights in certain healthcare specialties and/or for applying the insights, mine patient and healthcare provider data from multiple sources, including medical claims data, pharmacy claims data, eligibility and attribution data and clinical data from electronic medical records, to discover key analytical insights for decision support (20%)
- Review policies for payer contract programs, synthesize the information, and communicate the implications to our markets and executive leadership (10%)
- Build and continuously monitor reports and dashboards to track key yields, growth and performance metrics by payer. (10%)
- Provide direction in the development of proprietary analytical tools, such as predictive models (10%)
- Develop business and technical requirements for database and system development (10%)
Qualifications EDUCATION:
- Bachelor's degree in Mathematics, Statistics, Engineering, or Computer Science required.
- Master's degree preferred.
- Fellow, Society of Actuaries highly preferred.
EXPERIENCE:
- Must have at least three years of experience in management.
- 6+ years of experience working in healthcare and analytics required.
- Previous experience working with Python, R, or SAS required.