Actuary

Candidates hired for remote positions must reside in Oregon, Washington, Utah, Idaho, Arizona, Nevada, Texas, Montana, or Wisconsin.

Job Title

Actuary, Senior

Requisition

24950

Exemption Status

Exempt

Management Level

n/a

Direct Reports

n/a

Manager Title

Actuarial Services Manager

Department

Finance

Pay and Benefits

Estimated hiring range $135,420 - $165,520 / year, 5% bonus target, full benefits.

Posting Notes

This role is fully remote but you must reside in one of the listed 9 states.

Job Summary

This senior level position is responsible for performing a wide variety of financial and actuarial analyses impacting strategic decision making and the company's financial sustainability efforts. Areas of analysis include cost and utilization trend analysis, return on investment evaluations, Medicare bid development, rate setting optimization, forecasting support, benchmarking, risk adjustment optimization, provider payment evaluation and review of actuarial estimates such as IBNR and PDR. This position provides financial stewardship by identifying opportunities for improved financial performance.

Essential Responsibilities

Financial and Actuarial Analyses

Drill down into cost and utilization trends to identify key drivers.
Develop profitability analytics to support evaluation by provider group, contract, and other valued indicators.
Design, develop, and implement evaluation tools in measuring the effectiveness of programs and payment models.
Develop cost savings calculators for use in goal setting, budgeting, and forecasting.
Provide rate setting support through data analysis, policy review and strategy development.
Identify any actuarial unsound adjustments to the rates.
Provide medical cost and utilization trend recommendations for forecasting purposes.
Gather and develop benchmarks for purposes of assessing our performance and the potential for improvement.
Monitor risk adjustment applied to capitation revenue and ensure population risk is appropriately represented in encounter data.
Evaluate provider payment models, including risk share arrangements, to ensure they achieve the desired outcome.
Prepare regular risk share reporting for sharing with providers and supporting accounting estimates.
Drive strategic use of data to support business efficiencies and competitive decision-making.
Review and provide guidance on actuarial estimates of IBNR, PDR and other actuarially determined assets and liabilities.
Coordinate and review the work of outside actuaries to facilitate access to plan information necessary to support their work and ensure the company's interests are represented.

Financial Analytical Capacity and Capability

Work with Information Systems to ensure access to a data source with high data integrity.
Work collaboratively with the Business Intelligence department and other analysts to share best practices around using the data, ensure strong data governance and maintain a community of practice resource.
Provide training and support to other Finance users around the data, software, and analytic approaches.

Administration

Participate in 1:1, team, and department meetings.
Attend All Staff meetings.
Draft, recommend, and implement plans, policies, and procedures.
Participate in Actuarial Services team goal setting.
Train, mentor, and evaluate performance of assigned actuarial staff.

Organizational Responsibilities

Perform work in alignment with the organization's mission, vision and values.
Support the organization's commitment to equity, diversity and inclusion by fostering a culture of open mindedness, cultural awareness, compassion and respect for all individuals.
Strive to meet annual business goals in support of the organization's strategic goals.
Adhere to the organization's policies, procedures and other relevant compliance needs.
Perform other duties as needed.

Experience and/or Education

Required

Associate of the Society of Actuaries
Minimum 5 years' experience in an actuarial role
Work experience in health insurance

Preferred

Fellow of the Society of Actuaries
Work experience in Medicaid or Medicare

Knowledge, Skills and Abilities Required

Knowledge

Working knowledge of other MS tools, including MS Office products, MS Access
Strong understanding of data systems and sources and how it impacts the data available
Knowledge of medical claims, billing practices and health insurance requirements

Skills and Abilities

Strong data management skills

Proficiency in SAS, SQL, or similar database querying tools
Proficiency in MS Excel
Highly effective communication skills, including listening, verbal, and written
Willingness to acquire new skills
Ability to effectively lead and participate on a variety of large projects, including complex initiatives across departments
Ability to identify, implement, and lead process improvements
Strong ability in articulating and presenting information across multiple areas of the organization
Ability to communicate and present to external parties (e.g., auditors, actuaries, regulatory agencies) and stakeholders (e.g., Finance committees, Board of Directors, etc.)
Ability to collaborate effectively with department management
Strong attention to detail and accuracy
Ability to produce high quality output
Ability to effectively review others' work
Ability to identify problem, inconsistencies, unexpected results, relevant information, and uncertainties
Ability to interpret and analyze information and implement conclusions/solutions
Ability to assist team members in developing conclusions and solutions
Ability to effectively prioritize own work and complete tasks on time
Ability to effectively collaborate with coworkers, leaders, executives, and stakeholders
Ability to learn from feedback and embrace change
Possess a high degree of initiative, motivation, and professionalism
Ability to maintain a positive attitude
Ability to work effectively with diverse individuals and groups
Ability to learn, focus, understand, and evaluate information and determine appropriate actions
Ability to accept direction and feedback, as well as tolerate and manage stress
Ability to see, read, and perform repetitive finger and wrist movement for at least 6 hours/day
Ability to hear and speak clearly for at least 3-6 hours/day

Working Conditions

Work Environment(s): Indoor/Office Community Facilities/Security Outdoor Exposure

Member/Patient Facing: No Telephonic In Person

Hazards: May include, but not limited to, physical and ergonomic hazards.

Equipment: General office equipment

Travel: May include occasional required or optional travel outside of the workplace; the employee's personal vehicle, local transit or other means of transportation may be used.

Work Location: Work from home

Candidates of color are strongly encouraged to apply. CareOregon is committed to building a linguistically and culturally diverse and inclusive work environment.

Veterans are strongly encouraged to apply.

We are an equal opportunity employer. CareOregon considers all candidates regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, genetic information, disability, or veteran status.

Visa sponsorship is not available at this time.