Actuarial Analyst II (Medicare)

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:

CareSource 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):

Organization 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.