Actuarial Services Manager - Jefferson Health Plan

Jefferson Health Plans; Philadelphia (Philadelphia County); On-site; USD 95,000 - 130,000; Full time

Benefits offered by this job

Medical insurance

Tuition assistance

Retirement plans

Dental and vision

Job summary

Jefferson Health Plans seeks an Actuarial Associate/Manager to support the Director of Actuarial Services in Medicaid, CHIP, ACA and Medicare line analyses. The role involves improving models, conducting routine and ad hoc analyses, and supporting regulatory filings.

Responsibilities include monthly IBNR estimation, reporting, data extraction via SQL, and collaboration with auditors and consultants to ensure accuracy and timely decision support.

Qualifications

• Bachelor’s degree in Actuarial Science, Mathematics, Statistics or related field.
• 3 years actuarial experience in Medicaid, health care data reporting and analysis.
• ASA - Associate of the Society of Actuaries required.

Responsibilities

• Estimate monthly IBNR and maintain/improve models and processes.
• Communicate results to management and identify problem areas.
• Collaborate with Utilization Management to identify large cases and estimate potential liability.
• Provide financial reporting support and budgeting/forecasting.

Skills

Excel VBA

SQL

Actuarial Analysis

Problem Solving

Education

Bachelor's Degree Actuarial Science/Math/Stats

Tools

Access

Job description

Number of Positions In Requisition

1

Job Details

The Actuarial Associate and Manager is responsible for supporting the Director of Actuarial Services in all phases of the Actuarial Department’s needs. The Actuarial Associate and Manager will improve analytics and business decision support; improve information and processes in all aspects of the Medicaid and CHIP lines of business in addition to reserving, budgeting, forecasting, and regulatory filings. The Actuarial Associate and Manager will be actively involved individually and with other staff in the completion of different routine and ad-hoc analyses of an actuarial or financial nature under the guidance of the Director of Actuarial Services.

Job Description

• Estimate monthly IBNR and maintain & improve models and processes.
• Communicate results to management identifying any problem areas.
• Work closely with Utilization Management to identify and monitor potential large cases and estimate JHP’s potential liability.
• Financial reporting support.
• Financial budgeting and forecasting.
• Unit cost and utilization trend development and analysis.
• Actual vs expected analytics with analysis of variance.
• Risk pool and risk sharing estimation & analysis.
• Maintain and enhance internal data systems thru SQL.
• Prepare and validate various routine and ad hoc analyses to support the business decision process.
• Design and build models to support such analyses.
• Employ various data mining techniques.
• Function as an internal Medicaid actuarial point of contact between external auditors & consultants, and internal actuarial management.
• Support all state and federal regulatory reporting and filing requirements including but not limited to the annual CHIP rate filing.
• Support the ACA and Medicare lines of business as needed.
• Produce and maintain documentation of all routine and periodic processes.

Education and Experience:

• Bachelor’s Degree Actuarial Science, Mathematics, Statistics or other analytical field of study required
• 3 years Actuarial experience in Medicaid, health care data reporting and analysis required
• ASA - Associate of the Society of Actuaries - Society of Actuaries Required

Knowledge, Skills and Abilities - Required

• Ability to independently perform reasonability checks on completed work and recognize where further analysis is needed to understand and explain results
• Strong problem-solving, quantitative and analytical skills.
• Ability to use computer spreadsheet (Excel, VBA), database (Access and others) at advanced level to design and build reports & models.
• Self-motivated and able to juggle multiple priorities.

Knowledge, Skills and Abilities - Preferred

• Familiarity with SQL is a strong plus.

Work Shift

Workday Day (United States of America)

Worker Sub Type

Regular

Employee Entity

Health Partners Plans, Inc.

Primary Location Address

1101 Market, Philadelphia, Pennsylvania, United States of America

Nationally ranked, Jefferson, which is principally located in the greater Philadelphia region, Lehigh Valley and Northeastern Pennsylvania and southern New Jersey, is reimagining health care and higher education to create unparalleled value. Jefferson is more than 65,000 people strong, dedicated to providing the highest-quality, compassionate clinical care for patients; making our communities healthier and stronger; preparing tomorrow’s professional leaders for 21st-century careers; and creating new knowledge through basic/programmatic, clinical and applied research. Thomas Jefferson University, home of Sidney Kimmel Medical College, Jefferson College of Nursing, and the Kanbar College of Design, Engineering and Commerce, dates back to 1824 and today comprises 10 colleges and three schools offering 200+ undergraduate and graduate programs to more than 8,300 students. Jefferson Health, nationally ranked as one of the top 15 not-for-profit health care systems in the country and the largest provider in the Philadelphia and Lehigh Valley areas, serves patients through millions of encounters each year at 32 hospitals campuses and more than 700 outpatient and urgent care locations throughout the region. Jefferson Health Plans is a not-for-profit managed health care organization providing a broad range of health coverage options in Pennsylvania and New Jersey for more than 35 years.

Jefferson is committed to providing equal educational and employment opportunities for all persons without regard to age, race, color, religion, creed, sexual orientation, gender, gender identity, marital status, pregnancy, national origin, ancestry, citizenship, military status, veteran status, handicap or disability or any other protected group or status.

Benefits

Jefferson offers a comprehensive package of benefits for full-time and part-time colleagues, including medical (including prescription), supplemental insurance, dental, vision, life and AD&D insurance, short- and long-term disability, flexible spending accounts, retirement plans, tuition assistance, as well as voluntary benefits, which provide colleagues with access to group rates on insurance and discounts. Colleagues have access to tuition discounts at Thomas Jefferson University after one year of full time service or two years of part time service. All colleagues, including those who work less than part-time(including per diemcolleagues, adjunct faculty, and Jeff Temps), have access to medical (including prescription) insurance.