Actuary, Senior

Working Conditions

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

$ - $

Bonus - SIP Target, 5% Annual

Current Care Oregon Employees:
Please use the internal Workday site to submit an application for this job.

• 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.

• 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.

• 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.

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

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

• 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

• 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…