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SalaryWellBe Senior Medical is an innovative, risk-bearing provider organization focused on delivering the highest quality geriatric care (care of older adults) to frail, elderly Medicare Advantage patients with multiple chronic medical conditions. This population is typically underserved and very challenged with access to quality care. To address these problems, WellBe has elected to bring the care to the patient inside their own homes, instead of trying to bring the patient to the care. Care is provided in the home by fully employed, multi-disciplinary care teams throughout the entire continuum of care – from chronic care and urgent care in the home to end of life care. WellBe's physician-led care teams provide “concierge” level geriatric medical care and social support in the home as well as delivering and coordinating care across the entire continuum.
GENERAL JOB SUMMARY
This is a highly unique role at an innovative, fast-growing value-based healthcare company. WellBe began serving its first patients in 2020 and has been growing at a 150% average growth rate since inception. Because WellBe’s contracts with MA plans are structured as value-based care full-risk arrangements, our actuarial department is growing as well. As the third actuarial employee, you will be tasked with leading the actuarial work related to new health plan partnerships. This job has significant long-term growth opportunity.
We are looking for an Actuarial Manager to join our team and support our actuarial functions related to new health plan contracts. In this role, you will work closely with our Chief Growth Officer, CFO, and Head of Actuarial Services to manage all actuarial work needed for potential new Medicare plan partners. We have a robust growth pipeline that requires a skilled individual to oversee all actuarial tasks needed to evaluate potential partnerships. This position would be the first actuarial resource solely dedicated to new business development. The work includes, for example, reviewing data quality, meeting with Medicare plans, developing opportunity analyses aligned with the goals of potential plan partners, and streamlining the process for future plan evaluations to shorten our sales cycle. The ideal candidate will have strong technical skills including analytical skills, experience in healthcare actuarial analysis, ability to own a project, timely turnaround of work, and excellent communication skills.
Responsibilities:
- Streamline the process to evaluate potential partnerships with Medicare plans
- Process and summarize Medicare Advantage eligibility, claims, and revenue data from Medicare plans
- Assessment of data quality
- Develop a sound actuarial baseline based on the medical loss ratio of historical WellBe cohort performance
- Assist in the creation and review of global risk contracts between WellBe and MA plans to ensure the company is adequately protected
- Develop actuarial adjustments to the baseline including IBNR, seasonality, revenue projections, and others
- Achieve alignment on the view of the historical claim and revenue performance with external Medicare plan actuaries
- Collaborate alongside our Chief Growth Officer and Chief Financial Officer on new plan analyses
- Present findings and recommendations to key internal and external stakeholders
Educational and Experience Requirements:
- Bachelor’s Degree in Actuarial Science, Mathematics, Statistics, or related field
- ASA, MAAA credentials
- Minimum 5 years of experience in healthcare actuarial analysis
- Preferred experience working in Medicare Advantage and CMS standardized files
- Experience with actuarial modeling and assumptions
- Coding experience
Required Skills and Abilities:
- Strong analytical skills, including proficiency in Excel and coding
- Excellent communication and presentation skills, with the ability to explain complex actuarial concepts to both technical and non-technical stakeholders
- Ability to clearly communicate data questions and concerns
- Detail-oriented with the ability to manage multiple projects and prioritize effectively
- Demonstrated understanding of risk-Based Contracting and performance analysis
- Understanding of Medicare Advantage
- Ability to turn around work efficiently to meet the timelines of external health plans
Travel requirements: Travel may be required up to 10% locally or nationally.
Work Conditions: Ability to lift up to 20lbs.
