Actuarial Analyst, Senior

Your Role

 

The Network and Trend Analytics team drives the development of an affordable provider network through data analytics and expertise. The Senior Actuarial Analyst will report to the Senior Manager. In this role you will perform financial analyses and modeling for provider contracting support including term changes, renewals, network changes, and terminations for hospitals, ambulatory surgery centers and other types of providers.

Your Work

 

 

In this role, you will:

• Understand the core principles and functionality of decision, descriptive and predictive analytic methods including forecasting, statistical and machine learning techniques
• Conduct and develop analysis, assess risk and population risk scores and assignment, develop pricing and trends, assess changes in benefit designs, develop reserves, perform forecasting, analyze provider reimbursement terms and/or evaluates actuarial risk related analysis 
• Coordinate, prepare, perform and audit actuarial analyses to assist in the development of complex actuarial formulations leading to the recommendation of pricing, trending, reserving, provider reimbursement and/or risk assessment strategies
• Perform data exploration using a combination of statistical programming languages (including, but not limited to R, Python, SQL, SAS) and deploy predictive analytics and machine learning techniques to improve risk prediction, improve reserve, trend and financial forecasting in a manner that is actuarially sound, and enable real-time results and operational efficiencies 
• Develop evaluation and financial reporting standards for internal and external reports
• Conduct independent analysis of high complexity under moderate supervision and guidance, develop novel analyses and reports 
• Develop documentation and create and execute workplans for analyses of high complexity
• Create financial unit cost trend reporting and rate calculations under moderate supervision using Excel modeling tools
• Run and maintain SAS queries to gather data required for complex financial analysis
• Reprice historical data against provider contract terms based on deep understanding on contract structure and configuration
• Analyze contract rate proposals from hospitals and ambulatory surgery centers to assess the financial and trend impact 
• Partner with network management department in maintaining and developing the provider network and contracting strategy

 

Your Knowledge and Experience

 

• Requires a bachelor’s degree with at least a minor in mathematics, statistics, computer science or equivalent business experience

• Requires at least 3 years of professional actuarial experience

• Requires 2 years of experience in Health Care (managed care, academic, or government payer)

• Requires experience analyzing healthcare claims data, trends, and forecasting

• Requires proficiency in Excel and comfort working with large data sets

• Requires an ASA designation or has the majority of the courses completed to receive an ASA designation

• Knowledge of SAS is preferred