Actuary Lead- Value Based Contracting (Remote, US)

UPMC Health Plan has an exciting opportunity for an Actuary Lead on their rockstar Value-Based Contracting Team!

This position applies knowledge of mathematics, probability, and statistics in order to identify issues and gather and analyze data on a wide variety of topics affecting the financial performance of the health plan. Ensure timely and accurate services to clients. Supports strong internal and external relationships.

Preferences:

• Working experience in SQL and Excel
• Experience following fields: value-Based Contracting, pricing, reserving, trend/health economics, provider network analysis, risk adjustment, etc
• FSA or ASA

This role can be remote anywhere within the US!

Responsibilities:

• Presents results of analyses and recommendations to actuarial management.
• Develop junior actuarial department staff
• Support the Medicare Bid process, including preparing presentations, providing all requested reports and pricing, responding to desk review queries, and working with other departments to file all bids in a timely manner
• Responsible for the preparation of financial analyses in support of the following functions: Medical cost and utilization trend analysis; Forecasting; – Provide analytical support for rate development and filings; – Provide ad hoc data analysis to all departments within the company.
• Documents methods, procedures and results.
• Provide actuarial support and requests for the annual CMS Financial Audits; communicate with auditors when needed
• Will direct junior actuarial department personnel in the performance of duties.
• Price, analyze, and assign annual premium increases/decreases to Medicare Employer Groups; includes communication with product development/ sales and the ability to explain pricing decisions to senior management
• Review of other’s work product.
• Prepares and reviews Medicare Bid Submissions.
• Responsible for the development of mathematical models in connection with other departments to predict the impact of proposed changes.
• Will own project management of projects, including deliverables and appropriate work.

• Bachelor’s degree in mathematics, statistics, actuarial science, economics, or related field
• Five plus years of experience in actuarial work in health insurance, managed care or related consulting business; or equivalent training, education, and/or experience.
• Excellent problem-solving and analytical skills.
• In-depth understanding of health insurance market dynamics.
• ASA certification at minimum

Licensure, Certifications, and Clearances:
ASA certification, min

• Act 34

• UPMC is an Equal Opportunity Employer/Disability/Veteran