CareFirst Careers

Actuarial Associate (Provider Network Support & Provider Contracting - will consider REMOTE applicants)

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.

PRINCIPAL ACCOUNTABILITIES:

Include but are not limited to the following:

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.

Provider Contracting:

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, Heathway’s) and analyze changes to reimbursement to hospitals and physicians.

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.

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.

QUALIFICATION REQUIREMENTS:

  • BS or BA in Actuarial Science, Finance, Mathematics or a math-related field

  • 3 years of health insurance, actuarial pricing experience

  • 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

  • Must be able to independently manage both staff and individual projects. 

  • Demonstrated understanding of valuation concepts.

 

Abilities/Skills:

  • 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.

  • 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.

  • Negotiating and consulting skills.

  • Work in team environment.

Strongly Preferred:

  • Supervisory experience.

  • Experience with trend analytics and/or value-based contracting.

Remote Requirements:

For Remote employees – this position will be approximately 75% remote. 

 

If a potential candidate prefers to be based out of our Owings Mills or Northern Virginia office, CareFirst may provide Relocation Assistance.

#LI-KL1

 

PHYSICAL DEMANDS:

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.

Department

Department:

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

Closing Date

Please apply before: 4/5/2020

Federal Disc/Physical Demand

PHYSICAL DEMANDS:

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

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