Provides actuarial services in support of Medicare business.
With specific responsibilities of Medicare rate filing for both EmblemHealth and ConnectiCare.
Additional responsibilities of financial performance tracking and trend analysis.
Responsibilities:
Participates in product development, pricing, and rating implementation of new and existing Medicare business, including support in the filing of Medicare Advantage bids for both EmblemHealth and ConnectiCare.
Supports analysis of inpatient facility, outpatient facility and professional claims experience, measures utilization levels and trends, evaluates cost and intensity levels and trends, and performs various other actuarial and mathematical analyses.
Supports analysis of drug claims experience, measures utilization levels and trends, evaluates cost and intensity levels and trends, and performs various other actuarial and mathematical analyses.
Track development and accuracy of Medicare pricing/budget assumptions and develop actionable items to address variances.
Analyze the impact of existing and forthcoming healthcare reform in Medicare Advantage.
Responsibilities:
At least 2 SOA exams passed required
Bachelor’s degree in Economics, Mathematics, or similar major required; advanced degrees a plus
2+ years health insurance actuarial experience, preferably in Medicare required
Proficient in Excel required
Associate of the Society of Actuaries preferred
5+ years health insurance actuarial experience, preferably in Medicare preferred
SAS experience preferred
Advanced understanding of actuarial principles and methodologies required
In-depth knowledge of the Health Insurance industry required
Excellent mathematical and analytical skills required
Able to communicate effectively in writing and verbally required
