Actuary - Medicare Stars and Quality

Highmark Health; Raleigh (NC); On-site; USD 103,000 - 165,000; Full time

Job summary

Highmark Inc. is seeking an ASA-certified actuary to lead development of advanced actuarial models and analyses focused on forecasting Medicare Advantage Star Ratings. You will analyze data from CMS, HEDIS, and claims, guiding cross-disciplinary teams and mentoring junior staff.

You will proactively monitor Star Ratings methodologies, present findings to leadership, and apply actuarial techniques to quality improvement initiatives within a dynamic health plan setting.

Qualifications

• Bachelor's Degree in Actuarial Science, Mathematics, Statistics or closely related field.
• 5 years Actuarial experience in area of specialization.
• Associate of the Society of Actuaries (ASA) certification.
• Pursuing FSA exams toward FSA Certification is preferred.

Responsibilities

• Define and diagnose problems; outline data requirements and devise solutions.
• Initiate and lead studies, analyses, and materials for decision makers across teams.
• Ensure internal/external consistency and perform reasonability checks.

Skills

ASA certification

Actuarial modeling

Data analysis

Leadership

Communication

Mentoring

Stakeholder management

Education

Bachelor's Degree in Actuarial Science, Mathematics, Statistics or closely related field

Job description

Company :

Highmark Inc.

Job Description :

JOB SUMMARY

This job is an ASA Certified actuary position that initiates and leads development of advanced actuarial models and analyses specifically focused on forecasting Medicare Advantage Star Ratings. Proactively monitors and analyzes developments and changes to Medicare Advantage Star Ratings methodologies and included measures. Gives direction to less experienced staff and will represent the department's perspectives and needs in cross disciplinary settings. The incumbent will also apply actuarial techniques and statistical analysis in the development and evaluation clinical quality improvement initiatives utilizing a variety of healthcare data sources including claims, enrollment, clinical, HEDIS, and CMS data.

ESSENTIAL RESPONSIBILITIES

• Define & diagnose a problem. Outline data requirements for a study or analysis and devise insightful and creative solutions. Uncover the root causes of problems and reject superficial explanations. Review the appropriateness of the results in light of experience and industry knowledge. Consider alternate explanations or viewpoints before drawing conclusions.

• Initiate and lead the development of studies, analyses, and presentation materials needed to appropriately inform decision makers. Make appropriate recommendations to management across teams both within and outside of the actuarial department while understanding the implications and consequences to all stakeholders.

• Proactively ensure the internal and external consistency of all work. Use advanced industry knowledge to both perform reasonability checks as well as exceed customer expectations. Identify methods to test whether suspect results are correct. Form reasonable approximations in advance of results of an analysis and determine whether deviations are reasonable or suspect. Clarify information as needed.

• Take the initiative to utilize internal and external knowledge forums to gain broader industry perspective. Demonstrate subject matter expertise and as a result is sought out by others for technical input on producing accurate and efficient work. Promptly and efficiently identify outliers and anomalies in the work of others.

• Exhibit a thorough understanding of both corporate and division goals and values. Apply corporate, professional, and industry knowledge & insight to all tasks under incumbent's control or influence. Use expertise to envision and implement innovative new processes and propose changes to existing processes, leading to improved outcomes that better conform to corporate goals, objectives, and values. Demonstrate a capacity to shift between “big picture” and “detailed” thinking when analyzing issues and their strategic importance.

• Independently manage own time and resources across many projects. Demonstrate responsiveness, confidence, flexibility and ability to independently prioritize when shifting from one task to another. Comfortable in a dynamic, changing environment. Approach new challenges with anticipation and a view towards success. Identify emerging opportunities, establish project objectives, specify strategies, and organize necessary tasks. Keep manager informed.

• Interact with stakeholders in a manner that fosters cooperation and teamwork while conveying engagement and competence. Enhance department influence by providing responsive service and understanding customer needs. Effectively and confidently present information and provide decision support to team members and executive management. Consider alternate points of view on issues, demonstrating sensitivity to others’ situations. Maintain positive, productive working relationships despite differing or conflicting situations and personalities. Correctly interpret direct and indirect messages and verbal and non-verbal behaviors and respond appropriately.

• Engage, motivate, and mentor less experienced staff on a regular basis in a positive manner that fosters teamwork and excellence. Listen, take direction, accept criticism and feedback and adjust behavior accordingly to improve performance. Demonstrate flexibility and proactively take on additional work as needed by the team, leading by example.

• Represent department's perspectives and needs in cross disciplinary settings, and negotiate appropriate compromises and solutions in a way that results in effective action. Tailor work to the needs of direct management and business partners and make recommendations that have an impact beyond their role. Assume responsibility for own actions and the consequences for actions undertaken and decisions made.

• Other duties as assigned or requested.

EDUCATION

Required

• Bachelor's Degree in Actuarial Science, Mathematics, Statistics or closely related field

Substitutions

• None

Preferred

• None

EXPERIENCE

Required

• 5 years Actuarial experience in area of specialization

Preferred

• Pursuing FSA exams towards FSA Certification

LICENSES AND CERTIFICATIONS

Required

• Associate of the Society of Actuaries (ASA)

Preferred

• Fellow of the Society of Actuaries (FSA)

SKILLS

• Possesses and applies a comprehensive and in-depth knowledge of actuarial principles, concepts, practices and processes within multiple fields or disciplines

• Possesses significant expertise to complete complex assignments and ability to visualize, articulate, and solve complex problems while leading others to complete complex assignments

• Develops, designs, and tests analytic frameworks to solve complex problems using innovative approaches

• Assignments are broad in scope and require depth of knowledge as well as ingenuity and originality

• Analytical Skills

• Oral & Written Communication Skills

• Problem-Solving

Language (Other than English):

None

Travel Requirement:

0% - 25%

PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS

Position Type

• Office-based
• Teaches / trains others regularly
• Frequently
• Travel regularly from the office to various work sites or from site-to-site
• Rarely
• Works primarily out-of-the office selling products/services (sales employees)
• Never
• Physical work site required
• Frequently
• Audible Speech
• Constantly
• Hear
• Constantly
• Position self or move lower on ground, under tables/desks, etc.
• Never
• Climb
• Never
• Drive
• Occasionally
• Reach
• Frequently
• Sedentary position
• Frequently
• Move
• Frequently
• Repetitive Motion
• Frequently
• Use Hands/Fingers to Handle or Feel (beyond just data entry)
• Frequently
• Vision – Distinguish Color
• Frequently
• Vision – Far, Near, Depth Perception
• Frequently
• Move, transport, transfer – up to 10 lbs (Sedentary Work)
• Occasionally
• Move, transport, transfer – up to 20 lbs (Light Work)
• Occasionally
• Move, transport, transfer – up to 50 lbs (Medium Work)
• Occasionally
• Move, transport, transfer – excess of 50lbs (Heavy Work)
• Never

Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job.

Compliance Requirement: This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies.

Pay Range Minimum:

$102,700.00

Pay Range Maximum:

$164,600.00

Base pay is determined by a variety of factors including a candidate’s qualifications, experience, and expected contributions, as well as internal peer equity, market, and business considerations. The displayed salary range does not reflect any geographic differential Highmark may apply for certain locations based upon comparative markets.

Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against all individuals based on any category protected by applicable federal, state, or local law.

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