Actuary - Care Delivery Finance

Profile

Description

The Actuary, Analytics/Forecasting will be the actuarial leader within Care Delivery finance. They will be the national subject matter expert (SME) for financial claims analytics and work in conjunction with Market Leadership, Care Delivery Population Health and Analytics, and Care Delivery Finance. They will have access to service fund claims across a large Payor Agnostic ecosystem as CenterWell / Conviva is nationally the largest Senior Focused Primary Care company.

Responsibilities

The Actuary, Analytics/Forecasting will be the actuarial leader within Care Delivery finance. They will be the national subject matter expert (SME) for financial claims analytics and work in conjunction with Market Leadership, Care Delivery Population Health and Analytics, and Care Delivery Finance. They will have access to service fund claims across a large Payor Agnostic ecosystem as CenterWell / Conviva is nationally the largest Senior Focused Primary Care company. The Actuary will be comparing utilization patterns across different contracting arrangements as we move into contracting with MA LPPO Risk along with Direct Contracting with CMS (DCE). The actuary will be responsible for setting reserves in excess of $200M in claims for accurate forecasting of financial planning along with appropriate cash flow for our private equity partners (WCAS). Finally, the actuary will be responsible for selection of Stop Loss protection with payer partners for downside risk mitigation.

Claims Analytics Subject Matter Expert for Care Delivery Finance

Compare utilization patterns across various populations

Set IBNR for Conviva / CenterWell

Stop loss election and forecasting

Required Qualifications

Bachelor's Degree

FSA with at least 1 year of healthcare industry experience or ASA with at least 3 years of healthcare industry experience

MAAA

Professional experience in SQL, or an equivalent programming language

Experience in more than two functions (e.g., modeling, pricing, rate filing, reporting & analysis, reserving or trending)

Preferred Qualifications

Experience in Valuations

Experience in Claims Analytics

Additional Information

Interview Format:

As part of our hiring process for this opportunity, we will be using an exciting interviewing technology called Modern Hire to enhance our hiring and decision-making ability. Modern Hire allows us to quickly connect and gain valuable information for you pertaining to your relevant skills and experience at a time that is best for your schedule.

If you are selected for a first round interview, you will receive an email correspondence inviting you to participate in a Modern Hire interview. In this interview, you will have a set of interview questions and you will provide recorded video responses to each question. You should anticipate this interview to take about 15 - 20 minutes. Your recorded interview will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews.

Alert: Humana values personal identity protection. Please be aware that applicants selected for leader review may be asked to provide a social security number, if it is not already on file. When required, an email will be sent from Humana@myworkday.com with instructions to add the information into the application at Humana's secure website.

Scheduled Weekly Hours

40

Company info

Humana Inc.
Website : http://www.humana.com