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Form of work
SalaryJob Summary:
This is an Actuary position within the Risk Adjustment department. This position will require deep and significant analysis, and data-mining, to ensure that accurate claims/encounter data. Develop mathematical modeling techniques and statistical concepts to determine probability and assess risks. This position will need to work closely with a multitude of departments, being able to rapidly understand and navigate new situations and to be able to create solutions on the go.
Perform and support trend analysis
Perform risk adjustment analytical studies that involve manipulations of large amounts of data.
Identify patterns and trends in diagnostic coding practice in conjunction with risk score measurement.
Conduct gap analysis and data collection and validation.
Stay abreast of government regulations as related to the 3R’s.
Quantify and project risk scores and revenue for the Medicare line of business
Serve as subject matter expert for Medicare regulations, procedures, and requirements
Conduct complex actuarial analyses to assess risk scores
Create data-driven solutions for capturing risk and improving quality of care for our members
Perform vendor return on investment analyses to determine ongoing benefit and decision support
Develop and execute work plans that may involve collaboration with more than one team
Identify systems and operational problems, and recommend solutions and changes to streamline procedures for more effective reporting
Perform root cause analysis
Present and explain results to executive leadership
Other responsibilities as assigned
Analyze enrollment and claims data for patterns and trends to identify opportunity to improve documentation and coding.
Monthly P&L financial reconciliations and frequent liaisons with the Finance team
Present reports, explaining their implications to managers and directors, and advising on risk limitation
Communicating with internal clients and carrying out relationship with financial directors and stakeholders
Ad-hoc modeling and projects.
Education/Experience:
Requires a Bachelor’s degree, preferably within Mathematics, Statistics, Actuarial Sciences or a related field from an accredited college or university
2 years of actuarial and/or statistics experience
Experience in the health insurance industry preferred
Associate, Society of Actuaries (ASA) preferred
Knowledge:
Requires working knowledge of Excel
Prefers working knowledge of Access or other database application
Prefers experience with SAS or other programming language
Prefers knowledge of data analysis and Actuarial principles
Requires good oral and written communication skills
Requires strong analytical thinking
Requires strong mathematical skill and statistical analysis abilities
Requires good judgment and problem solving skills
Medicare or Commercial Risk Adjustment experience
Other healthcare experience, especially technical experience
Skills and Abilities:
Requires good oral and written communication skills
Requires strong analytical thinking
Requires strong mathematical skill and statistical analysis abilities
Requires good judgment and problem solving skills
This compensation range is specific to the job level and takes into account the wide range of factors that are considered in making compensation decisions, including but not limited to: education, experience, licensure, certifications, geographic location, and internal equity. This range has been created in good faith based on information known to Horizon at the time of posting. Compensation decisions are dependent on the circumstances of each case. Horizon also provides a comprehensive compensation and benefits package which includes:
Comprehensive health benefits (Medical/Dental/Vision)
Retirement Plans
Generous PTO
Incentive Plans
Wellness Programs
Paid Volunteer Time Off
Tuition Reimbursement
Job Type: Full-time
Salary: $80,657.94 - $100,502.03 per year
Schedule:
- 8 hour shift
- Monday to Friday
Ability to Relocate:
- Newark, NJ 07102: Relocate before starting work (Required)
Work Location: In person
