This position is responsible for assuring the fulfillment of health plan financial objectives for all PHP lines of business. Responsible for the management and oversight related to pricing formulas, trend analytics, forecasting, revenue and benefit expense budgeting, valuation, provider contracting analytics, and revenue liabilities and receivables. This role is a leader and an expert in these areas and demonstrates expertise in a variety of the fields' concepts, practices, procedures, laws and regulations. Relies on extensive experience and judgment to perform tasks and accomplish goals. Works well with other areas outside of the actuarial and financial analytics department to accomplish projects or assignments and is seen as a trusted finance representative. Provides counsel on a wide variety of actuarial and financial analytics topics as they relate to the health plan and the health insurance industry. A wide degree of creativity, flexibility, and latitude is expected.
MAJOR CHALLENGES:
- Many and conflicting business priorities.
ESSENTIAL FUNCTIONS
- Direct commercial group pricing, individual (both ACA and Medicare) rate setting, valuation (e.g. reserves), forecasting, budgeting, projecting provider risk sharing and alternative payment amounts, and estimating risk adjustment and risk transfer payment amounts.
- Key contributor in the annual budget process and ongoing long range planning process by assessing anticipated impact of industry and organization specific concepts including:
- Stars performance
- Medicare Advantage Bids and Benefit Modifications
- Medical and Pharmacy Trends
- RAF (Risk Adjustment) Performance
- Network Performance
- Mentor managers and analyst and fosters an environment the encourages innovation and continuous improvement.
- Ensure teams are using strong controls with a high degree of data quality and integrity.
- Ensure that teams are utilizing appropriate statistical and quantitative methods in order to translate data into meaningful and actionable information.
- Present key analyses with appropriate level of detail analysis for senior leaders.
- Manage vendor and consulting relationships.
- Routinely reviews team's performance.
- Ensures appropriate and efficient resource utilization to achieve company and Informatics' goals.
- Develops and measures against team's annual operating budget.
QUALIFICATIONS
- Bachelor's Degree in a highly quantitative field (e.g. Economics, Math, Statistics, Finance, Engineering)
- Upon hire: Fellow of Society of Actuaries (FSA)
- 7 years of experience in healthcare actuarial analytics
- 5 years of experience in managing analytic teams
- Demonstrated expertise in group, individual (e.g. ACA), and Medicare pricing and rate setting.
- Demonstrated expertise in reserving and valuation modeling.
- Demonstrated expertise in budgeting and forecasting techniques.
- Demonstrated knowledge in risk adjustment models (commercial, ACA, Medicare, and Medicaid)
- Demonstrated knowledge of alternative payment methodologies and provider risk sharing arrangements
- Demonstrated knowledge of statistical and quantitative methods
- Ability to translate data into meaningful and actionable information.
- Ability to solve complex problems including devising new analytic methods to solve unique problems.
- Ability to think strategically with appropriate level of detail analysis for specific audiences.
- Ability to effectively present to senior leaders drawing clear and concise conclusions.
- Mentor managers and analyst.
- Demonstrated ability to develop highly effective teams.
- Creates a culture that ensures strong controls, data quality, and integrity.
The amounts listed are the base pay range; additional compensation may be available for this role, such as shift differentials, standby/on-call, overtime, premiums, extra shift incentives, or bonus opportunities.
Check out our benefits page for more information about our Benefits and Rewards.
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