Description: The Actuary will ensure the fiscal integrity of the health plan's program and policy decisions and facilitate executive decision making by providing timely and accurate actuarial and financial analyses. The incumbent will be responsible for the ongoing financial planning and analysis needs of the organization, including the review and analysis of revenue, medical costs and their underlying trends.
What You Will Do:
Participates in a mission-driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability.
Develops clinical utilization, cost profiles and other indicators for all areas of medical costs, including but not limited to health plan's Direct, pharmacy and skilled nursing facilities.
Completes analysis to support regulatory filings, including state rate development models and Medicare Advantage bids.
Supports operating budget development and monthly reporting analysis.
Responsible for incurred but not reported reserves (IBNR) modeling and analysis.
Advises management of significant changes or unusual trends in medical costs and proposes recommendations for management consideration.
Supports activities related to regulatory and financial audits and findings.
Assists with the development of appropriate reimbursement rates and other financial contract provisions for health plan with the state of California.
Assists in evaluation of decision support and analysis tools, as well as improvements to the data warehouse.
Supports management with budgeting and forecasting duties.
Assists the team in carrying out department responsibilities and collaborates with others to support short- and long-term goals/priorities for the department.
Provides direction and guidance to Financial Analysis staff in accordance with established departmental and organizational policies.
Serves as primary liaison with external actuarial services and support.
Completes other projects and duties as assigned.
You Will Be Successful If:
Develop rapport and establish and maintain effective working relationships with leadership and staff and external contacts at all levels and with diverse backgrounds.
Work independently and exercise sound judgment.
Communicate clearly and concisely, both orally and in writing.
Work a flexible schedule; available to participate in evening and weekend events.
Organize, be analytical, problem-solve and possess project management skills.
Work in a fast-paced environment and in an efficient manner.
Manage multiple projects and identify opportunities for internal and external collaboration.
Motivate and lead multi-program teams and external committees/coalitions.
Utilize computer and appropriate software (e.g., Microsoft Office: Word, Outlook, Excel, PowerPoint) and job specific applications/systems to produce correspondence, charts, spreadsheets, and/or other information applicable to the position assignment.
Ability to visually read information from computer screens, forms and other printed materials and information.
Ability to speak (enunciate) clearly in conversation and general communication.
Hearing ability for verbal communication/conversation/responses via telephone, telephone systems, and face-to-face interactions.
Manual dexterity for typing, writing, standing, and reaching, flexibility, body movement for bending, crouching, walking, kneeling and prolonged sitting.
Lifting and moving objects, patients and/or equipment more than 50 pounds.
What You Will Bring:
Bachelor's degree in health care economics/planning, business, mathematics or related field required. Master's degree in health care economics/planning, business, mathematics or related field preferred.
Associate of the Society of Actuaries (ASA) certification required.
3 years of health care informatics or actuarial experience required.
An equivalent combination of education and experience sufficient to successfully perform the essential duties of the position such as those listed above may also be qualifying.
About Impresiv Health:
Impresiv Health is a healthcare consulting partner specializing in clinical & operations management, enterprise project management, professional services, and software consulting services. We help our clients increase operational efficiency by delivering innovative solutions to solve their most complex business challenges.
Our approach is and has always been simple. First, think and act like the customers who need us, and most importantly, deliver what larger organizations cannot do - provide tangible results that add immediate value, at a rate that cannot be beaten. Your success matters, and we know it.