Actuary, Senior

CareOregon, Inc.; Utah; Remote; USD 80,000 - 120,000; Full time

Job summary

An established industry player is seeking a Senior Actuary to perform critical financial and actuarial analyses that drive strategic decision-making. This fully remote role offers the opportunity to enhance financial performance through detailed cost and utilization trend analysis, Medicare bid development, and rate setting. The ideal candidate will have a strong background in health insurance and actuarial science, with a focus on collaboration and data governance. Join a diverse and inclusive team dedicated to improving business efficiency and making impactful decisions.

Qualifications

• At least 5 years of actuarial experience in health insurance.
• Experience with Medicaid or Medicare is preferred.

Responsibilities

• Analyze cost and utilization trends to identify key drivers.
• Develop profitability analytics for provider groups and contracts.
• Evaluate provider payment models to ensure desired outcomes.

Skills

SAS

SQL

MS Excel

Analytical Skills

Communication Skills

Leadership Skills

Education

Associate of the Society of Actuaries

Fellow of the Society of Actuaries

Tools

Data Systems

Claims and Billing Systems

Job description

Join to apply for the Actuary, Senior role at CareOregon.

This position is fully remote but candidates must reside in Oregon, Washington, Utah, Idaho, Arizona, Nevada, Texas, Montana, or Wisconsin.

Job Summary

This senior-level role involves performing a variety of financial and actuarial analyses to support strategic decision-making and financial sustainability. Responsibilities include cost and utilization trend analysis, Medicare bid development, rate setting, forecasting, benchmarking, risk adjustment, provider payment evaluation, and actuarial estimate reviews. The role aims to enhance financial performance through these analyses.

Essential Responsibilities

• Analyze cost and utilization trends to identify key drivers.
• Develop profitability analytics for provider groups, contracts, and other indicators.
• Create evaluation tools for program and payment model effectiveness.
• Develop cost-saving calculators for budgeting and forecasting.
• Support rate setting through data analysis and policy review.
• Identify and address actuarial inconsistencies in rate adjustments.
• Provide medical cost and utilization trend recommendations.
• Gather benchmarks for performance assessment and improvement.
• Monitor risk adjustment in capitation revenue and ensure accurate population risk representation.
• Evaluate provider payment models to ensure desired outcomes.
• Prepare risk share reports for providers and accounting estimates.
• Use data strategically to improve business efficiency and decision-making.
• Review actuarial estimates of liabilities and assets, coordinating with outside actuaries.

Additional Responsibilities

• Ensure access to high-integrity data sources.
• Collaborate with Business Intelligence and other teams to share best practices and maintain data governance.
• Provide training and support on data, software, and analytics.

Organizational Responsibilities

• Align work with organizational mission, vision, and values.
• Support diversity, equity, and inclusion initiatives.
• Meet business and strategic goals.
• Adhere to policies and procedures.

Minimum Qualifications

• Associate of the Society of Actuaries.
• At least 5 years of actuarial experience.
• Experience in health insurance.

Preferred Qualifications

• Fellow of the Society of Actuaries.
• Experience with Medicaid or Medicare.

Skills and Knowledge

• Knowledge of data systems, claims, billing, and health insurance.
• Proficiency in SAS, SQL, or similar tools, and MS Excel.
• Strong communication, leadership, and analytical skills.
• Ability to collaborate, prioritize, and adapt.

Work Conditions

• Remote work from home.
• Work involves standard office equipment and occasional travel.

CareOregon encourages candidates of color and veterans to apply and is committed to diversity and inclusion. Equal opportunity employer. Visa sponsorship is not available.