The Actuary will report to the Population Health VP, Analytics and work across internal teams to develop provider contracts in order to provide a higher quality of care. This position will develop and support the VBC strategy focused on meeting ever changing CMS reimbursement requirements as they move towards an emphasis on value of care and outcomes.
- Develop innovative provider contracts that result in improved quality of care and cost for commercial lines of business as well as Medicare.
- Develop new Value Based Care (VBC) programs with an eye for satisfying CMS reimbursement requirements as they are changing to recognize value in care over volume of care.
- Creation of pricing, customer quoting, and risk sharing materials to VBC constituents including ACO providers and Self-Insured customers.
- Create and review financial reconciliations for provider partners; contribute to the development and design of new tools to support the entire process.
- Perform ad hoc work related to the ongoing evolution of the ACO model, including researching potential methodology changes, development and creation of new tools, and development of marketing materials.
- As an expert on VBC, develop and implement actuarial and underwriting policies and procedures and providing case specific guidance/support.
- Identify medical trends and savings opportunities.
- Maintain and update actuarial models and proactively identify solutions.
- Collaborate and clearly communicate results and technical concepts.
- Analyze medical trends for new risks, opportunities, and saving opportunities.
- Remain up to date on all related regulatory requirements.
- Perform various financial analyses to include analyzing rate changes.
- Bachelor’s Degree in Actuarial Science, Math, Economics or related field required; Master’s Degree and/or PHD preferred.
- Must be a Designated Actuary with 7 years of experience.
- Experience in managed care, carrier environments, health informatics or medical-based accounting preferred.
- Experience working in a heavily regulated environment while interacting with state and federal government agencies is preferred.
- In depth knowledge of CMS Value Based Reimbursement Requirements.
- Advanced statistical knowledge and awareness of the larger trends in the health industry.
- Ability to communicate complicated statistical material clearly and concisely.
- Advanced proficiency with analytical & business intelligence tools (Excel, Tableau, etc.) preferred
- Working knowledge of data flow, analytics, warehouses and manipulation a plus
Integra Connect, LLC provides a comprehensive benefits plan.
- Medical/Dental/Vision Insurance beginning the 1st of the month following your date of hire
- 401k with employer match
- Paid Time Off
- Paid Holidays and Floating Holiday
Equal Opportunity Employer
|Job Category||Population Health|