Health Actuary Lead

POSITION TYPE

• Contract: 3+ Months

POSITION LOCATION

• 100% REMOTE

POSITION SUMMARY
Leads and directs actuarial work within organization for a number of health plan programs including commercial, Medicare Advantage, Medicaid and CMS ACO and Advanced Payment Programs. Develops forecasting models that utilize both payor claims data as well as EMR data to forecast future performance. Participates in contract negotiations with payors and performs analyses that support that contract negotiation process. Analyzes payor cost of care payment trends and utilization changes driving value based contracting results.

PRIMARY RESPONSIBILITIES

• Develops financial models using a blend of internal proprietary databases, data/information from health insurers and national databases to assess future financial risk on value-based agreements.
• Designs, develops, implements, and maintains financial forecasting model for the Medicare Shared Saving Plan Program agreement.
• Prepares and presents quarterly financial forecasts for value-based agreements.
• Researches and analyzes the impact of regulatory changes on financial performance
• Analyzes potential risks and trends that will affect financial outcomes of value-based agreements and advises leadership of recommendations for positive outcomes.
• Manages relationship with external actuarial consultants.
• Analyzes costs/benefits of stop loss/reinsurance programs.
• Develops shared savings models between us and other affiliated entities.
• Analyzes payor value based contracting proposals (including bundles and full-risk capitation) and proactively identifies value based contracting structures that would be most beneficial to us.

EDUCATION •

• Bachelor’s degree in Actuary Studies, Mathematics or Statistics

EXPERIENCE •

• Five years’ experience in Health Plan or Medicare Advantage/ACO actuarial consulting or provider health system experience with payor value based contracting models.
• Looking for someone with true Actuarial experience, credentialed as an ASA, prefer an FSA.

CERTIFICATIONS

• Associate of the Society of Actuaries (ASA)

HealthmarkIT is rooted in a culture of quality, integrity, transparency, and commitment.

We are a highly agile organization that brings years of success and consistency rarely found in Healthcare IT consulting. With our highly experienced and proficient consultants, HealthmarkIT can be trusted to alleviate your organization’s needs by ensuring you have the highest quality of individuals to fulfill your needs. In keeping business simple, our clients and consultants can focus on what they do best, and place the organization in the best position possible.