Note: The job is a remote job and is open to candidates in USA. WellSense Health Plan is a regional health insurance company serving members through Medicare, Individual and Family, and Medicaid plans. The Senior Actuarial Analyst supports actuarial analysis across pricing, reserving, medical economics, financial forecasting, healthcare data analytics, regulatory filings, and risk adjustment, while providing technical support to Finance and other departments.
Responsibilities
- Analyzes financial, statistical and mathematical data and performs actuarial calculations
- Leads or supports the rate development through analyses of benefit design, rating factors, claims experience, regulatory mandates, admin expense allocation, and projection of future claim cost
- Leads or supports regulatory rate filings, and prepares data for additional inquiries and requirements
- Leads or supports the development of monthly IBNR reserve estimates for different line of business
- Prepares monthly accruals and contract settlements for different line of business
- Leads or supports financial budget, reforecast and other financial projections
- Evaluates and makes recommendations regarding the adequacy of capitation rates from state Medicaid programs or other new program
- Leads or assists in risk adjustment analyses and risk score simulations
- Leads or supports trend development, trend drivers study, and/or provider contract analytics
- Maintains established reports for internal needs or regulatory requirements
- Participates in internal and external audits
- Participates in requirements gathering for and serves as delegate or backup for corporate initiatives/projects
- Generates ideas and analytical approaches for corporate initiatives/projects
- Designs or updates SQL/SAS queries and programs to extract data from data warehouse, and reviews the data to ensure accuracy and validity
- Serves as data expert for department
- Advises Finance department on data warehouse design, requests and works with IT to establish priorities
- Initiates and leads efforts to improve quality and efficiency of actuarial models, analyses and reports
- Summarizes findings and recommendations, documents the process
- Develops presentations and communicates to senior management or external parties
- Shares knowledge and provides training to new employees
Skills
- Bachelor's Degree in Mathematics, Actuarial Science, Finance, Economics or related fields
- At least 4 years of progressively responsible experience in actuarial analysis, data modeling, informatics and analysis
- Commensurate educational experience in related field will be considered
- Should be experienced in MS Office products, SQL, and SAS or other statistical software
- Should be proficient in Excel
- Should be an experienced user of healthcare data
- Ability to meet deadlines, multi-task, problem solve and use appropriate technology to analyze business problems
- Ability to work collaboratively with team members and other departments
- Strong communications skills
- A background in managed healthcare, insurance operations
- Master's degree
- ASA or FSA
Benefits
- Full-time remote work
- Excellent benefits
- Medical, dental, vision, pharmacy
- Merit increases
- Flexible Spending Accounts
- 403(b) savings matches
- Paid time off
- Career advancement opportunities
- Resources to support employee and family wellbeing
Company Overview