Senior Actuarial Manager

Baystate Health Senior Actuarial Manager Westfield, MA Apply Senior Actuarial Manager Hybrid Opportunity Share this job Save Apply now

Req:

R41936

Springfield, Massachusetts Full-Time First Health Insurance Payer Health Insurance Summary:

Schedule:

8am-5pm

Monday-Friday Location:

1 Monarch Place; Springfield MA; Hybrid Opportunity This position will perform actuarial analyses for Commercial, Medicaid and Medicare business including, but not limited to: medical expense analyses and projections, determining rates and preparing supporting documentation for rate filings with DOI, pharmacy analytics and projections, building and maintaining rate models, analyzing data in support of monthly reserve process, and ad hoc actuarial analyses. In addition this position will work closely with the legal department to identify, size and communicate financial risks and opportunities related to legislative and regulatory changes including impacts to premiums, benefits and product designs. Accountabilities Provide data and support for the development of rate filings for submission to the Department of Insurance and CMS. Closely monitors and assesses competitors\' rates, trends and rating methodologies. Supports various initiatives as needed by actuarial modeling. Develops/enhances ad hoc reports to assist in actuarial analyses of emerging results. Creates and maintains large databases of information utilizing a unique skill set of spreadsheet and relational database abilities. Assists in setting and documenting financial liabilities including IBNR Reserves, PDR, Risk Adjustment and other outstanding items. Conducts cross-functional analysis of health care data to identify trends and risks. Develop data and reports in support of reinsurance, risk adjustment and risk corridors, ensuring accurate impacts in pricing and coordination with rebate determination. Assess the financial or pricing impact of variations in benefits and provider contracts. Estimate mandated benefit cost and calculate pricing of benefit changes. Tracks trends and reports pertinent financial and utilization information. Perform other related projects and duties as assigned. Internal Finance Analytics and Reporting External Organization?s name

NCQA Dimensions Examples:

Business units supported Financial dimensions (e.g., capital budget, annual project cost, operating budget) Regulatory bodies and special requirements NCQA Accreditation standards HNE Policies and Procedures supporting NCQA standards Gap analysis Supports HNE LOBs to meet NCQA accreditation standards Education / Experience / Other Information (include only those that are specific to the role) Bachelor\'s Degree required, preferably in Actuarial Science/Mathematics/Finance/Healthcare Management or a related field or an equivalent combination of education and experience. 3-4 Actuarial Exams minimum, ASA preferred 2-3 years of previous experience. Excellent quantitative, problem solving and analytical skills. Strong communication skills. Technical skills with database concepts, data analysis development, data warehousing and decision support tools. Knowledge of MS-Office products, SAS or SQL required. Working Conditions Standard office-based environment; non-standard hours may be of occurrence. Limited travel required, usually pre-planned. Extensive period working with laptops and looking at monitors may cause visual discomfort.

Education:

Bachelors Degree (Required)

Certifications:

Minimally Required Expereince:

5 years nursing in related setting

Education:

Bachelors Degree (Required)

Certifications:

Certified Registered Nurse - OtherOtherOther, Registered Nurse - State of MassachusettsState of MassachusettsSta Active Filters Senior Actuarial Manager Westfield, MA Clear All Apply