Resp & Qualifications
PURPOSE: Performs actuarial and oversight skills in the performance of trend reporting and analytics to develop actionable items to manage claims costs. Provides actuarial support to Medical, Pricing and SBUs regarding provider contracting and network development, including actuarial modeling to support pricing and network strategy and development. Supports development and implementation of predictive analytics and other industry innovations including risk adjustment. Provides actuarial support for government programs including Medicare Advantage and Medicaid.
Include but are not limited to the following:
Trend Reporting and Analytics
Responsible for coordinating the development and extensive analytical review of trends. Provide analytical support for product development, forecasting, and enrollment and public policy objectives.
Evaluate new partnerships (e.g., the new Pharmacy Benefit Manager (PBM) CVS), monitor rates for our 5 capitated arrangements (i.e., Magellan, Davis Vision, McKesson, Health Fitness, Healthways) and analyze changes to reimbursement to hospitals and physicians.
Provider Network Support
Responsible for manager level support of provider network analytics, support and development. Manages actuarial analyst(s) in support of Medical Network area and assists in development and quantification of provider networks for pricing and rate filing.
Predictive Analytics and Risk Adjustment
Responsible for commercial ACA and Medicare Advantage risk adjustment analyses for rate development and revenue optimization. Tracks and incorporates industry innovations in actuarial and data science.
Manager level support and development for Managed Medicaid bid development and rate review. Perform actuarial analysis of cost and benefit components including network development and pricing. Provide support for Medicare Advantage bid development and cost analysis, working with actuarial consultant.
Responsible for coordinating the activities of the Actuarial Innovation and Research and Actuarial Staff, ensuring accurate and timely release of requested analyses and reports. This includes directing the workflow, reviewing the work and ensuring that sound actuarial and financial methods are used, and that the work is presented in a professional and easily understood manner. The Supervisor is also responsible for providing training, development, documenting performance issues, if needed, and monitoring and enforcing adherence to Company policies. The Supervisor sets objectives, writes and delivers Performance feedback and appraisals, promotions, salary increases, hiring and disciplinary communications (PIP, final warnings, etc.)
Actuarial Student Program:
Responsible for meeting all requirements established by the Actuarial Student Program as amended from time to time.
SUPERVISORY RESPONSIBILITY: Supervise and direct the workflow of assigned staff which may include: Senior Actuarial Analyst(s), Financial Actuarial(s) I & II, Interns and Actuarial Assistants, etc.
Position requires an individual with a BS or BA in Actuarial Science, Finance, Mathematics or a math-related field, 3 years of health insurance, actuarial pricing experience, and to be an Associate of the Society of Actuaries (ASA).
Position requires an individual who is highly analytical and possesses an in-depth understanding of health insurance products and markets. Must have comprehensive understanding of financial statements, and highly developed verbal and written communication skills, to the point where actuarial information can be completely and concisely presented to both an actuarial and non-actuarial audience. Detail oriented. Must be able to independently manage both staff and individual projects. Demonstrated understanding of valuation concepts.
Ability to organize and lead the team to task completion.
Plan and prioritize work.
Ability to mentor/review associates to accomplish assigned tasks and encourages and fosters associate development.
Ability to prepare ad-hoc analysis, experience studies and reports.
Intermediate computing skills with both PC base and mainframe applications.
Must demonstrate flexibility, innovation and problem-solving skills and resourcefulness.
Excellent business problem solving skills.
Someone who is respected by his/her peers and subordinates.
Excellent written and verbal communication skills.
Ability to express technical and financial analysis in a clear, concise manner on both written and oral form.
Negotiating and consulting skills.
Work in team environment.
Must be able to effectively work in a fast paced environment with frequently changing priorities, deadlines, and workloads that can be variable for long periods of time. Must be able to meet established deadlines and handle multiple customer service demands from internal and external customers, within set expectations for service excellence. Must be able to effectively communicate and provide positive customer service to every internal and external customer, including customers who may be demanding or otherwise challenging.
Experience with trend analytics and/or value-based contracting.
Department: Actuarial Innovation
Equal Employment Opportunity
CareFirst BlueCross BlueShield is an Equal Opportunity (EEO) employer. It is the policy of the Company to provide equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information.
Hire Range Disclaimer
Actual salary will be based on relevant job experience and work history.
Where To Apply
Please visit our website to apply: www.carefirst.com/careers
Federal Disc/Physical Demand
Note: The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes him/her ineligible to perform work directly or indirectly on Federal health care programs.
The associate is primarily seated while performing the duties of the position. The hands are regularly used to write, type, key and handle or feel small controls and objects. The associate must have sight.
The physical demands described here are representative of those that must be met by an associate to perform the essential duties and responsibilities of the position successfully. Requirements may be modified to accommodate individuals with disabilities.
Sponsorship in US
Must be eligible to work in the U.S. without Sponsorship