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

Date Posted: 10/21/2018

Job Snapshot

  • Employee Type:
    Full-Time
  • Location:
    Remote
  • Job Type:
  • Job ID:
    54652

Job Description

ABOUT THE POSITION

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.

TO APPLY

Click below on “Apply for this Position” to create a profile and apply for the position

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

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