Director New Business Evaluation & Implementation - Actuarial Services (Remote)

AmeriHealth Caritas; Newtown Square (Delaware County); Remote; USD 100,000 - 125,000; Full time

Job summary

An established industry player is seeking a Director for New Business Evaluation & Implementation in Actuarial Services. This remote position involves providing critical actuarial and financial support for evaluating new business opportunities and implementing strategies. The role requires strong analytical and communication skills to navigate complex financial projections and provider arrangements. Join a forward-thinking company dedicated to responsible managed care solutions, where your expertise will contribute to impactful initiatives in the Medicaid and Medicare sectors. This is an exciting opportunity to make a difference in healthcare management and drive growth within the organization.

Qualifications

• Bachelor’s Degree in Business Administration or Finance is required.
• 10 years of experience in health care business is preferred.

Responsibilities

• Provide actuarial, financial, and operational support for new business evaluation.
• Prepare analyses for financial projections and provider contracting.
• Participate in monthly financial close processes and communicate with auditors.

Skills

Analytical Skills

Communication Skills

Financial Feasibility Analysis

Technical Skills

Problem-Solving

Education

Bachelor’s Degree in Business Administration

Finance or related field

10 years of progressive health care business experience

Job description

Director New Business Evaluation & Implementation - Actuarial Services (Remote)

Pay: Competitive

Location: Newtown Square/Pennsylvania

Employment type: Full-Time

Job Description

Req#: 27901

Provides actuarial, financial and operational support for the evaluation of new business opportunities and the support of new business implementation. Also provides support to existing businesses. Participates in Strategic Development and Growth of Department.

• Acquire understanding of supporting state data sets and files used in financial feasibility analysis.
• Prepare reconciliations, issue identification and resolution.
• Acquire understanding of current state provider reimbursement arrangements and methodologies and changes over time.
• Prepare valuations of fee schedules and changes over time in support of financial projections and provider contracting.
• Acquire understanding of program changes over time.
• Demonstrate strong technical and communication skills in resolving issues with State Department of Medicaid, potential Business Partners and various AMFC departments.
• Review Requests for Proposal; identify issues affecting financial projections and/or cost proposals.
• Identification of the many issues inherent in new implementations, particularly around claim data, claim processing, provider configuration and revenue reimbursement.
• Prepare valuation of the impact of these issues to financial reporting estimates.
• Provide analytical support to cost containment initiatives and valuation of impacts.
• Provide analytical support to provider contract initiatives and valuation of impacts.
• Provide analytical support and valuation to various financial reporting elements including Revenue, Provider Accruals, Recoveries, Reinsurance, Open Authorization large claim valuations.
• Participate in monthly financial close process for supported businesses; provide documentation and explain calculations to auditors.
• Prepares analyses in support of Rate discussions and negotiations.
• Represents Actuarial Services Department on various company initiatives, ensuring that departmental needs are communicated and considered; provides feedback to the department.

Education/ Experience:

• Bachelor’s Degree in Business Administration, Finance or related field required.
• Medicaid Managed Care industry experience preferred.
• 10 years of progressive health care business experience.

About the company

AmeriHealth Caritas is a different kind of health care company. Our goal is to provide responsible managed care solutions, including Medicaid, Medicare, and CHIP — plus pharmacy benefit management, behavioral health, and administrative services.