Note: The job is a remote job and is open to candidates in USA. UPMC is a healthcare organization committed to improving the lives of patients, health plan members, and employees. The Managing Actuary will lead high-impact analyses and medical cost improvement strategies for UPMC Health Plan, including value-based contract modeling, utilization and cost trend analysis, and cross-functional strategy development. The role also supervises actuarial staff and communicates recommendations to senior leadership.
Responsibilities
- Partner with Health Plan senior leadership for creative problem-solving and strategic decision-making involving medical cost improvement strategies
- Direct a team to produce detailed actuarial and financial models which communicate near and long-term projections of financial performance of value-based provider reimbursement contracts to facilitate corporate decision-making and the development of strategies and goals
- Forecast and interpret financial results of value-based contracts, including variances from budget, to help identify opportunities and potential risks
- Develop healthcare claims cost and utilization trends for use in projections defining savings methodologies for provider arrangements such as ACO & PCMH contracts, global capitation, bundled rates, episodic payments, capitation, risk adjusted total cost of care, and value-based payments
- Develop and gain support for data-based recommendations with team members from product, clinical, network, and strategy functions
- Bring clarity to complex problems using exceptional communication skills when engaging with senior leadership and technical audiences
- Apply an understanding of complex actuarial concepts, methods, and applications in a variety of situations and deliver results to leadership
- Creatively leverage a wide range of datasets to inform key analyses
- Build strong relationships within cross-functional workgroups including Network, Pharmacy, Actuarial, Analytics, and Finance teams across the enterprise
- Ensure that departmental work products meet the highest standards of quality
- Manage and develop a team of 2-3 supporting staff including actuarial analysts
Skills
- Bachelor's degree in mathematics, statistics, actuarial science, economics, or related field required
- ASA certification by Society of Actuaries required; FSA preferred
- 6.5 years of experience in progressively more responsible actuarial work in health insurance/managed care or equivalent training/education
- In-depth understanding of health insurance market dynamics
- Excellent problem-solving and analytical skills
- Good oral and written communication skills
- Adaptability and ability to prioritize effectively
- Strong PC skills
- Data retrieval skills and relational database experience
- ASA or FSA certification by Society of Actuaries required
- Membership in the American Academy of Actuaries required
- Advanced degree preferred
- Experience in any of the following is a strong preference: development and settlement of value-based provider contracts, network and reimbursement methodology analysis, claims-based experience analysis, trend analysis
- Experience with commercial and government health programs preferred
- Management experience preferred
Benefits
- Support for professional designations through continuing education opportunities
- Work-from-home position located anywhere within the continental US
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