ACTUARY - APM REPORTING / ANALYTICS in Remote at Beacon Health Options

Date Posted: 10/21/2018

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Job Description


We are currently seeking a dynamic ACTUARY – APM REPORTING /ANALYTICS to join our Alternative Payment Models (APM) team remotely or at our office in Boston, MA.  The ACTUARY – APM REPORTING / ANALYTICS will leverage experience in health insurance, trend analysis and programming to produce actuarially sound reporting and analytics with a high degree of visibility.

Position Requirements:

  • Develop and maintain ROI analysis including identification of costs and benefits associated with new and existing APM performance metric gains
  • Design and implement total care model for BH membership, including working with internal and external clients to source medical and PD data and developing analysis around the interrelationships
  • Lead and coordinate utilization and pricing analysis that ensures appropriate claims assumptions are used for APM contracts
  • Build models and tools that properly normalize historical cost of care trends and identify future initiatives in order to accurately estimate future pricing trends
  • Complete recurring analysis of claims against rating assumptions by demographics, geographic region, aid category, etc. and suggest changes to rating assumptions to be made in negotiations APM providers
  • Collaborate with Clinical, Strategy and Operations teams to complete evaluations and analysis that fairly value the financial and care quality impact of clinical operational changes and product innovation
  • Evaluate encounter experience against negotiated payment rates for providers with whom Beacon Health Options has sub capitation agreements. Includes working directly with provider staff to:
    • Reconcile Beacon Health Options encounter data with provider encounter data
    • Construction and completion of experience report that reviews claims cost performance through:
      • Medical loss ratio analysis
      • Development of claims cost trend assumptions and utilization changes to estimate future cost of sub capitation
    • Collaborate with sub capitated providers to financially value network leakage and to then identify sources and solutions to minimize network leakage
    • Support provider network team in negotiation of final sub capitation rates with providers
  • Assist Actuarial Medical Accounting team to ensure appropriate values for sub capitation contracts are used in monthly accounting of liabilities
  • Collaborate with and mentor junior team members

       Education: Bachelor’s Degree in behavioral health, medical, or health administrative field.

Licensure :  ASA (Associate of Society of Actuaries) OR 4+ exams

Relevant Work Experience:  5 years of experience in health insurance. 2+ years working with MS SQL Server

Knowledge, Skills & Abilities :

  • Excellent verbal communication and speaking skills
  • Excellent writing skills
  • Leadership and strategic planning
  • “Intermediate to Expert level” computer skills to manage projects including at least Excel, Word, and experience with project management software.


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Beacon Health Options company is proud to be an Equal Opportunity and Affirmative Action Employer as well as a Drug Free and Tobacco Free Work Environment. EOE/AA/M/F/Veterans/Disabled