Actuarial Lead Position Available In Allegheny, Pennsylvania

Pittsburgh, PA
4 DAYS AGO
21517530
Summary
Pittsburgh, PA
$160102.10 – $160102.10 per Year
2 Years Experience
Master’s degree
No Commisssion
40.00 hours per week / Day Shift /Full-Time
Description

ACTUARIAL LEAD

(Multiple Openings) -UPMC Health Plan in Pittsburgh, PA seeks multiple Actuarial Leads to apply knowledge of mathematics, probability and statistics to identify issues, gather and analyze data on a wide variety of topics affecting the financial performance of the health plan. Assist with reconciling Medicare Advantage Part C and Part D claims data to financials. Analyze bid projections of Part B and Part D rebates. Evaluate impact of proposed legislative and regulatory changes. Develop assumptions, project costs and monitor emerging experience of Medicare Advantage Mandatory Supplemental Benefits including, but not limited to, transportation, vision, healthy foods, fitness and flex card. Develop and analyze trend selections of various service categories including inpatient, outpatient, skilled nursing facility, durable medical equipment, Part B, ambulance, lab, physician and home health. Assist with providing related party reporting regarding the Medicare Advantage Bid process. Develop automation to assist with benefit pricing during the bid process and benefit changes during rebate reallocation leveraging VBA and knowledge with JSON files. Perform competitive benchmarking on plan designs, profit margins and administrative expense using financials from statutory filings. Respond to requests from CMS bid desk reviewers and other auditors. Supervise junior staff, including actuarial analysts, in the completion their projects. Assist with setting Premium Deficiency Reserves. Supervises an actuarial analyst. Master’s degree, or equivalent, in Actuarial Science, Mathematics, Statistics, Economics, or related field plus two (2) years of actuarial experience in health insurance/managed care, actuarial consulting to health actuaries, or related experience: valuating and pricing Medicare (Part C and Part D); building financial risk models from start to finish; working with CMS BPTs (both Part C and Part D) and required reporting elements such as CMS MLR; responding to and providing quantitative support for CMS for bid desk review, financial audit, and full bid audit; developing risk scores, employing different risk models; managing or training junior staff; utilizing tools and technologies including: SQL or SAS, Excel including VBA, macro development, data retrieval, and Power BI. Must hold ASA or FSA certification by Society of Actuaries. Telecommuting permissible. Apply by following these steps; visit http://careers.upmc.com and enter 2500015S in the “Search Keyword/Job ID” field and click Go. EOE/Disability/Veteran.