Job Description

It's rewarding to be on a team of people that truly believe in making an impact!

We are committed to building the best primary care environment for patients and are seeking healthcare enthusiasts to join us.

Job Summary

As a Senior Actuary within the Finance Department, you will assist with complex actuarial and medical economics projects including trend calculations, reserving estimates, risk score calculations, risk assessments and savings analyses. You will build risk adjustment and medical economic models used to forecast revenue, cost and utilization trends that will be used in the company’s short and long-range planning. You will work collaboratively with clinical and operations leaders to drive performance.

Responsibilities

• Perform and support trend analysis of medical and pharmacy claims data for the Medicare and Medicaid lines of business
• Collaborate with Operation teams on quantification and tracking of trend initiatives that will impact financial results
• Calculate RAF score projections utilizing benchmarks and historical operational improvement experience at region and/or markets for use in finance reporting and forecasting
• Collaborate with Operations and Coding teams on documentation initiatives that may impact RAF score projection
• Conduct complex actuarial analyses to assess risk scores
• Identify and implement appropriate analytic and forecasting methodologies
• Build financial/actuarial models to support budget and forecasting
• Compile, organize, categorize, and analyze large data sets using SQL
• Assist in leading complex analytic projects leveraging data from multiple sources
• Assist with the design and development of dashboards and key performance indicator reports to meet business needs
• Ad-hoc modeling and projects.

Supervisory Responsibilities

• No supervisory responsibilities

Education & Experience

• Requires a Bachelor's degree, preferably within Actuarial Science, Finance/Accounting, Mathematics, Statistics or a related field from an accredited college or university
• 3-5 years of actuarial and/or statistics experience
• Experience in the health insurance industry (Medicare)
• Associate, Society of Actuaries (ASA) preferred

Preferred Qualifications

• Understanding of CMS guidelines and specifications as it relates to Medicare Advantage and Risk Adjustment models
• Experience measuring impact and ROI of operational programs and services related to medical and pharmacy cost reduction initiatives
• Familiarity with medical economics and actuarial forecasting
• Experience in predictive modeling, data manipulation, reporting, and analysis
• Experience synthesizing analysis into actionable and easy to digest insights
• Demonstrated proficiency with SQL
• Proficient with MS Excel, including creating Macros, Power Pivot Tables, SUMIFS, SUMPRODUCT, and VLOOKUPs, etc.

Physical Requirements

This position works under usual office conditions. The employee is required to work at a personal computer as well as be on the phone for extended periods of time. Must be able to stand, sit, walk and occasionally climb. The incumbent must be able to work extended and flexible hours and weekends as needed. Physical demands include ability to lift up to 50 lbs. The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of the job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Work Conditions

Must be able to perform essential functions such as typing, standing, sitting, stopping, and occasionally climbing.

Travel Requirements

Amount of Expected Travel

Details

No

Tools & Equipment Used

Computer and peripherals, standard and customized software applications and tools, and usual office equipment.

Disclaimer

The duties and responsibilities described above are designed to indicate the general nature and level of work performed by associates within this classification. It is not designed to contain, or be interpreted as a comprehensive inventory of all duties, responsibilities, and qualifications required of associates assigned to this job. This is not an all-inclusive job description; therefore, management has the right to assign or reassign schedules, duties, and responsibilities to this job at any time. Cano Health is an equal opportunity/affirmative action employer. All qualified applicants will receive consideration for employment without regard to sex, gender identity, sexual orientation, race, color, religion, national origin, disability, protected veteran status, age, or any other characteristic protected by law.

Join our team that is making a difference!

Job Tags

Similar Jobs