Health Insurance Actuarial Manager
Pittsburgh, PA 15219 US
Must have 6 or more years of actuary work and management experience within value-based contracting and commercial pricing for health insurance plans.
In this role you will ensure that the Actuarial Department provides excellent services to various internal and external clients in the areas of provider relations, contracting and forecasting. You will be responsible for supervising actuarial analysts.
- Determine performance measures, associated benchmarks, and other contractual components to include in newly-formed value-based contracts.
- Provide reports for the purpose of evaluating and advising management on the financial impact of proposed provider agreements or changes to existing agreements
- Analyze Fee For Service arrangements, contract changes, and project future unit cost trends.
- Calculate values of network relativity factors used in rating and underwriting.
- Evaluate and model alternative payment models
- Provide expertise to Contracting and Network services areas in rate modeling and fee schedule preparation, training, process development, etc.
- Work closely with Enterprise Risk Management and key internal stakeholders to build and enhance insurance (underwriting and reserving) risk assessment, monitor changes to the risk profile, risk analytics, and understand key drivers
- Bachelor's degree in mathematics, statistics, actuarial science, economics, or a related field required.
- Advanced degree preferred.
- 6 to 7+ years of experience in actuary work and management within value-based contracting and commercial pricing for health insurance plans.
- Excellent problem-solving and analytical skills.
- Good oral and written communication skills.
- Strong PC skills.
- Ability to solve issues with a sense of urgency
- ASA or FSA certification by Society of Actuaries required.
- Membership in the American Academy of Actuaries required.
Healthcare - Value Based Contracting - Actuarial Manager - 26453