Actuary- Value Care

Overview

Performance and maintenance of the monthly incurred but not reported (IBNR) healthcare claims process for a large risk based multi-specialty value-based care organization. Serve as a subject matter expert on IBNR estimates and payor data files. Investigate and analyze utilization and medical cost data in support of financial close, budget, and forecasting processes.

• Create the monthly claim triangles, populate the IBNR models, and produce the IBNR estimates, working closely with accounting, finance, and operational leaders. Communicate results and supporting information to internal audiences including Finance, Accounting, and Value Based Care executives and team members. Maintain the IBNR models. Research issues and trends and keep leaders informed of findings. Update related monthly reports. Act as key contributor and subject matter expert during budget and forecast cycles.
  
  Interact with payor contacts and third-party actuaries as appropriate. (70%)
• Support the annual financial statement audit. Prepare lookback analyses and other information as requested by the auditor. Meet with the auditor as needed to answer questions. (5%)
• Perform medical expense projections and evaluate against payor contracts. (10%)
• Perform ad hoc analyses as requested by management. Independently surface insights and recommendations that help improve the accuracy of IBNR models and/or value-based care operations. (15%)

• Role is viewed as a primary subject matter expert on all matters related to IBNR and will be looked to for advice, guidance, and mentorship.
• Manage entire IBNR process, on a monthly basis, to completion, meeting predetermined timelines.

License / Registration / Certification

• Associate of the Society of Actuaries (ASA)
• Member of the American Academy of Actuaries (MAAA)

Level of Education

• BS or BA

Field of Study

• Actuarial Science, Mathematics, Statistics, Economics, or a related area

Years of Experience

• Minimum of five years of US healthcare actuarial work experience in managed care or closely related field, with at least 2 years estimating IBNR claims

Describe Type of Experience

• Experience supporting the monthly IBNR process (preferably 3+ years)
• Experience developing and maintaining complicated EXCEL/VBA models and presenting results (preferably 7+ years)
• Knowledge of IBNR methodologies and concepts
• Strong understanding of the US healthcare system
• Ability to work effectively with other team members, auditors, payor contacts, and third-party actuaries
• Ability to communicate complex concepts to technical and non-technical audiences
• Understanding of financial statements
• Understanding of relational databases
• Understanding of medical and pharmacy trends
• Understanding of medical claims coding and categorization
• Advanced knowledge of Excel
• Knowledge of SQL/Databricks
• Ability to write and edit VBA macros preferred
• Ability to identify and drill down into causes of changes in medical expenses

The compensation for this role includes a base pay range of $92K-$138K, with the actual pay determined by factors such as skills, experience, education, certifications, geographic location, and internal equity. Additional compensation may be available through shift differentials, bonuses, and other incentives. Base pay is only a portion of the total rewards package.