Industry: Patient Care•
5 - 7 years
Posted 368 days ago
Skills and Responsibilities:
1) Independently produces and provides analytical and technical support for assigned projects using data analysis tools and software (SQL, Microsoft Office, QLIK, CDIS, R, SAS, etc.).
a. Project focus area may include:
i. Budget, trend and cost containment analysis
ii. Vendor and strategic business partner relationship development
iii. Monthly claim reserve and IBNR projections
iv. Product pricing (rate filings and Medicare bid)
v. Competitor benchmarking
vi. Statutory financial and key performance indicator reporting
vii. Government and financialaudit support
viii. Risk adjustment and reinsurance modeling
ix. Implementation and monitoring of value-based care initiatives
2) Performs complex analyses by utilizing a wide-range of quantitative and qualitative data sets, models, and publications (regulations, guidelines, business rules, reporting requirements and standards).
a. Data sets and models may include:
i. Health Plan data sets (Operational Data Store (ODS), claims, enrollment, revenue, finance, vendor data)
ii. Actuarial Models (Trends, Budget, Reserving, Pricing)
iii. Risk adjustment models
iv. Underwriting and rating models
v. CMS and DHS guidelines
vi. Market and trend data
vii. Other industry-related publications or data sets (MedPAC, Milliman, etc.)
viii. Enterprise Data Warehouse
3) Analyzes data output to identify and interpret trends or patterns in complex data sets
4) In collaboration with others, applies advanced business, statistical, and actuarial concepts (Credibility, Simulation, Frequency, Severity) to help support and enhance decision making.
5) Synthesizes information to create and deliver clear, precise, and actionable information to stakeholders. This information may be delivered in writing or through verbal summaries/dashboards/reports/presentations.
6) Validates and exchanges data provided to and/or received from other departments, strategic business partners, or other external parties.
7) Develops and maintains technical business rules and documentation for data mart metrics and tables owned by or sourced from Actuarial Services.
8) Serves as subject matter expert or data steward in data governance and quality initiatives to ensure and maintain integrity of GHP data stores.
9) Completes ad-hoc requests.
10) Supports team members.
1) Serves as a liaison to all levels of Health Plan staff including leadership, other departments, Medical Directors, external vendors, and business partners as requested to analyze data sets and information.
2) Maintains strong relationships across departments through collaboration and effective communication.
1) Provides technical, analytical and business guidance within actuarial team and across GHP departments as necessary.
2) Mentors or supervises analysts or interns. Must communicate well and assist with tasks as appropriate, provide guidance as needed, assist in the yearly performance evaluations, etc.
3) Monitors and translates key reimbursement, healthcare reform, and regulation policy issues that may impact the Health Plan. Independently develops detailed recommendations and operational strategies to implement these changes and present to senior management.
1) Maintains a high level of proficiency in use of business intelligence and reporting tools including:
a. MS SQL Server Components (Query Analyzer & coding, Analysis Server, Stored Procedures and Jobs)
c. Operational Data Store
d. Business Objects (Crystal Reports, Crystal Enterprise, Web Intelligence, Voyager, OLAP and Xcelsius)
e. Statistical Programming (SAS, R)
f. Microsoft Office (Word, Excel, PowerPoint and Access)
g. Core claims system
2) Maintains a strong healthcare, insurance, technical and analytic knowledge base. Continuously enhances personal skillsets through pursuit of industry knowledge. Specific opportunities for development include, but are not limited to:
a. Research new or advanced topics (webinars, software programs, journal articles, legislation, etc.)
b. Complete AHM/AHIP/AHIMA coursework
c. Pursue actuarial designation (ASA, FSA) through Society of Actuaries
d. Obtain CPC/CRC coding credentials
e. Pursue post-baccalaureate education (Master’s degree, PhD, etc.)
3) Continuously develops and enhances the skill sets of direct report(s) (where applicable).
4) Participates in meetings as required.
Perform other duties as required or assigned.
Competencies and Skills
1) Exhibits strong analytical, problem solving, strategic and critical thinking, decision modeling, and organizational skills.
2) Ability to work in a dynamic environment while demonstrating ability to produce timely, accurate, and appropriately detailed analytics
3) Demonstrates general knowledge of actuarial science, mathematics, or statistics, including ability to perform financial analyses and create models.
4) Demonstrates effective communication skills (interpersonal, presentation, written).
5) Demonstrates proficiency in Excel, PowerPoint, Word and Access. Technical knowledge of statistical software (R, SAS, etc.) and data query tools such as SQL preferred.
Education and Experience
Bachelor’s Degree in Actuarial Science, Risk Management, Economics, Mathematics, Computer Sciences, or other data relevant field required.
Minimum five years related professional work experiencerequired; in a progressive healthcare setting preferred.
Associate’s Degree in Actuarial Science, Risk Management, Economics, Mathematics, Computer Sciences, or related field required and eight years of related professional experience in a healthcare setting required.
Note: Three completed actuarial exams may be substituted for up to two years of experience.
Experiencereporting from relational databases and financial modeling preferred.
Job Id 43215