Purpose:The Department of Health Economics is seeking a Managing Actuary! This credentialed healthcare actuary would drive high-visibility impactful analysis and would be responsible for developing and driving medical cost improvement strategies for UPMC Health Plan in collaboration with leadership. This includes developing and evaluating financial outcomes of value-based contracts, analyzing medical cost utilization and unit cost data, identifying top trend drivers of contract performance, developing strategies across cross-functional teams such as Network, Actuarial, Finance, and Clinical, and supporting the execution of those strategies.
The Managing Actuary will require a diverse set of skills and experience, including data and analytics expertise, broad-based business and health economics acumen, a strategic mindset, and an ability to influence and leverage cross-functional teams in a non-traditional actuarial environment. This position will supervise 2-3 supporting staff, including actuarial analysts, in the performance of duties.
As a Managing Actuary at UPMC, you will be given support for professional designations through continuing education opportunities. This position is a work-from-home position located anywhere within the continental US.
Responsibilities: - Partner with Health Plan senior leadership for creative problem-solving and strategic decision-making involving medical cost improvement strategies.
- Direct a team to produce detailed actuarial and financial models which communicate near and long-term projections of financial performance of value-based provider reimbursement contracts to facilitate corporate decision-making and the development of strategies and goals.
- Forecast and interpret financial results of value-based contracts, including variances from budget, to help identify opportunities and potential risks.
- Develop healthcare claims cost and utilization trends for use in projections defining savings methodologies for provider arrangements such as ACO & PCMH contracts, global capitation, bundled rates, episodic payments, capitation, risk adjusted total cost of care, and value-based payments.
- Develop and gain support for data-based recommendations with team members from product, clinical, network, and strategy functions.
- Bring clarity to complex problems using exceptional communication skills when engaging with senior leadership and technical audiences.
- Apply an understanding of complex actuarial concepts, methods, and applications in a variety of situations and deliver results to leadership.
- Creatively leverage a wide range of datasets to inform key analyses.
- Build strong relationships within cross-functional workgroups including Network, Pharmacy, Actuarial, Analytics, and Finance teams across the enterprise.
- Ensure that departmental work products meet the highest standards of quality.
- Manage and develop a team of 2-3 supporting staff including actuarial analysts.
Qualifications: - Bachelor's degree in mathematics, statistics, actuarial science, economics, or related field required. Advanced degree preferred.
- ASA certification by Society of Actuaries required; FSA preferred.
- 6.5 years of experience in progressively more responsible actuarial work in health insurance/managed care or equivalent training/education.
- Experience in any of the following is a strong preference: development and settlement of value-based provider contracts, network and reimbursement methodology analysis, claims-based experience analysis, trend analysis
- Experience with commercial and government health programs preferred.
- In-depth understanding of health insurance market dynamics.
- Excellent problem-solving and analytical skills.
- Good oral and written communication skills.
- Adaptability and ability to prioritize effectively.
- Strong PC skills.
- Data retrieval skills and relational database experience.
- Management experience preferred.
Licensure, Certifications, and Clearances: - ASA or FSA certification by Society of Actuaries required.
- Membership in the American Academy of Actuaries required.
