Our client, a leading healthcare organization, is seeking an Actuarial Services Manager to join their team. This role will involve developing medical reserving methodologies, creating actuarial forecasts, and evaluating financial risks and opportunities for the organization. The ideal candidate will have significant actuarial experience, a deep understanding of the Medicare space, and the ability to use data analytics to drive decision-making and optimize healthcare operations.
Responsibilities:
- Perform thorough analysis, financial forecasts, and actionable insights to aid in decision-making by utilizing data analytics and business intelligence tools.
- Create and manage Medicare Advantage, Medicaid, and Medicare ACO business lines' IBNR reserving models.
- Create long-term medical and revenue projections by analyzing company and industry data.
- Assess and revise the accrual model and risk adjustment prediction for mid- and end-of-year true-ups.
- Determine areas where healthcare operations can increase efficiency and reduce costs.
- Examine trends in healthcare use and collaborate with medical management teams to find areas that could benefit from optimization and better resource allocation.
- Keep abreast on market developments, reimbursement policy changes, and laws pertaining to the healthcare sector.
- To match plans with overarching organizational objectives, collaborate closely with senior leadership, medical economics, health services, finance, and other departments. Extra responsibilities as delegated
Skills and Requirements for the Position:
- BA Degree required
- Designation as an ASA or FSA
- 5+ of increasing actuarial experience, ideally with Medicare Advantage bid submission and/or Medicare ACO experience strong familiarity with healthcare laws, rules, and market trends
- Knowledge of provider payment systems, payer contracts, and healthcare reimbursement procedures
- Adept at using a variety of data analytics tools and technologies, including VBA, SQL, PowerBI, PowerPivot, PowerQuery, and macros
- Adept at using Microsoft Office (Word, Excel, PowerPoint) and Google Suite (Drive, Docs, Sheets, Slides)
