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:
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.
Evaluate new partnerships (e.g., new value based payment arrangements with health systems and/or large provider groups, monitor rates for our capitated arrangements, 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.
Responsible for coordinating the activities of the 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 as 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.).
Position requires an individual who is:
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. Occasional walking or standing is required. The hands are regularly used to write, type, key and handle or feel small controls and objects. The associate must frequently talk and hear. Weights up to 25 pounds are occasionally lifted.
Sponsorship in US
Must be eligible to work in the U.S. without Sponsorship