Not for profit blue plan in PA. PM if interested, I will send the HR contact
info.
Generally we don't sponsor.
Job Summary Responsibilities
Responsible for all Actuarial support relating to Contracting and Provider
Incentive Programs. This role actively works with the Provider Contracting
area to evaluate the impact and performance of various rate changes and
incentive programs. Once those assessments are performed, this role
ensures that they are built into the medical cost trend projections. This
role also functions as the point of contact for Actuarial for all issues
relating to Provider Incentive Programs.
Duties:
1. Working with the Contracting area, develops monthly unit cost projections
and analysis for
use in the medical cost projections.
2. Understands and assesses the impact of changes in provider reimbursement
on unit cost,
utilization and mix of services.
3. Designs, prepares and presents reports on unit cost initiatives, both
historical and
projected.
4. Completes and reports valuations of Incentive programs, rate increases
and other provider
reimbursement tools and tracks performance against goals.
5. Performs other duties and special projects as required.
6. Potential to supervise a junior actuarial associate.
Required Qualifications
* Bachelors degree in Mathematics, Statistics, Economics or Actuarial
Science
* ASA or FSA Required
* Six (6) years of experience in a Health Insurance Actuarial department (
preferably managed
care)
* Solid mathematical background including extensive experience working with
risk models,
actuarial or mathematical analysis, and using automated or statistical
analysis tools.
* Proven ability to manage projects to a successful conclusion as well as
the ability to identify
best practices and methods
* Effective facilitation and presentation skills required in order to
demonstrate business
solutions in a clear and concise manner to all levels of management
* Strong organizational, analytical and project planning skills
