Actuarial Analyst II (Medicare)
Ohio WFH, United States
Job Summary:
The Actuarial Analyst II (Medicare) is responsible for providing timely, accurate, and actionable data, analysis and recommendations supporting the department, area, and corporate key initiatives.
Essential Functions:
- Develops actionable recommendations to management relative to all analysis
- Calculates profitability reports on appropriate business segments
- Leads regular and ad-hoc analysis identifying opportunities to improve efficiency and affordability
- Leads regular and ad-hoc analysis/studies to evaluate assumptions used in other processes
- Participates in cross functional teams to address key issues facing the organization
- Prepares monthly calculation of the company's IBNR reserves
- Evaluates government reimbursement process to determine areas of risk and opportunity
- Participates in initiatives to improve operating results
- Initiates key analysis to improve overall MLR results
- Performs other duties as assigned
Preferred Experience:
- Experience with Medicare Advantage bids
- Experience with data compilation to support bids
- Experience with desk review audit responses
- Experience developing and using pricing models related to Medicare Advantage
- Experience with Medicare Risk Adjustment
- Experience with building large Excel models
- Proficient with relational databases and coding languages (SQL)
- Experience with DSNP and/or FIDE/HIDE-SNPs
Education and Experience:
- Bachelor's degree in actuarial science, mathematics, economics or a related field is required
- Minimum of one (1) year of decision support or financial analysis experience is preferred
- Intermediate database (SAS or Access) experience is required
- Managed Care or healthcare experience is preferred
Competencies, Knowledge and Skills:
- Intermediate interpersonal/verbal communication skills and a high level of professionalism
- Intermediate written communication skills
- Intermediate ability to work independently and within a team environment
- Intermediate ability to work in fast paced environment with changing priorities
- Intermediate ability to remain calm under pressure
- Intermediate proficiency level with Microsoft Excel
- Intermediate proficiency with Microsoft Suite to include, Word, Power Point and Outlook
- Intermediate ability to effectively present information and respond to questions from peers and management
- Intermediate ability to analyze and interpret financial data in order to coordinate the preparation of financial records
- Intermediate knowledge of SQL, SAS, R, or other data manipulation software
- Effective problem-solving skills with attention to detail
- Effective listening and critical thinking skills
Licensure and Certification:
- A combination of years of industry experience and exams passed under the Society of Actuaries Exam Syllabus (excluding exam SRM via transition credit) equaling 5 or more is required
- Active pursuit of an actuarial designation (ASA) is required
Working Conditions:
- General office environment; may be required to sit or stand for extended periods of time
Compensation Range:
$70,800.00 - $113,200.00CareSource takes into consideration a combination of a candidate’s education, training, and experience as well as the position’s scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. We are highly invested in every employee’s total well-being and offer a substantial and comprehensive total rewards package.
Compensation Type (hourly/salary):
SalaryOrganization Level Competencies
Create an Inclusive Environment
Cultivate Partnerships
Develop Self and Others
Drive Execution
Influence Others
Pursue Personal Excellence
Understand the Business
This job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an inclusive environment that welcomes and supports individuals of all backgrounds.
ApplyJob Profile
Comprehensive rewards package Comprehensive total rewards package General office environment Inclusive environment Well-being investment
Tasks- Cross-functional team participation
- Data Analysis
- Government reimbursement evaluation
- Improve operating results
- Monthly reserve calculations
- Operating results improvement
- Profitability reporting
Access Actuarial science Analysis Attention to detail Coding Communication Critical thinking Data analysis Data manipulation Decision support Economics Excel Financial analysis Healthcare Interpersonal Interpersonal Communication Managed Care Management Mathematics Medicare Medicare risk adjustment Microsoft Excel Microsoft Suite Organization Outlook Pricing models Problem-solving R Relational databases Risk Adjustment SAS SQL Teams Training Word
Experience1 years
EducationBachelor's degree Business Healthcare Related Field
Certifications TimezonesAmerica/Anchorage America/Chicago America/Denver America/Los_Angeles America/New_York Pacific/Honolulu UTC-10 UTC-5 UTC-6 UTC-7 UTC-8 UTC-9