Use Your Strengths at Wellmark as an Actuary!
As an Actuary as Wellmark, you will support business strategies related to financial risk for your assigned market segments by evaluating competitiveness associated with provider networks, premium rate setting, risk adjustment methodologies, exchanges (public and private), new technology, legislative and regulatory changes, utilization management programs, and other market forces. You will determine forecasts and trends, as appropriate, along with collaborating and building/maintaining relationships with key customers and strategic partners.
Aside from meaningful and challenging work, we offer:
NOTE: This role is required to be onsite in Des Moines, IA on Tuesdays, Wednesdays, and Thursdays every week.
Required:
Preferred:
a. Provide analysis and recommendations in order for assigned market segment(s) to achieve corporate profitability objectives, by initiating analyses based on review of the market segment(s) that are both assigned and initiated.
b. Provide dependable, accurate and timely information regarding rates, trends, rating factors and formulas to support internal stakeholder functions (e.g. Underwriting, Product Development). Provide information relating to regulations and rules. Consult on various issues related to rating of specific groups or benefits.
c. Develop rates, rating factors and rate filings. Develop and maintain rating methods and models. Develop and maintain sound liability estimation methodologies.
d. Initiate comprehensive and timely data analysis of health care trends and financial measures with summary conclusions. Collaborate and partner with Business Analytics staff regarding data analysis for assigned work.
e. Maintain, forecast, and provide oversight for needed rate increases by assigned market segments. Use data collection and research methodologies that meet established actuarial guidelines for statistical accuracy and that will produce reasonable results.
f. Perform peer review activities including reviewing data, formulas and calculations as needed to validate work products completed by others. Reviewer should also be able to sign off and certify that work is in accordance with standard actuarial principles and is in accordance with any regulatory guidelines.
g. Calculate adequate unpaid claims liabilities, with direction, as assigned. Provide information as needed for financial reporting (e.g. reserves, annual statement exhibits).
h. Provide technical input on changes to existing and new regulation rules; including recommendations that contribute to top-level decision-making regarding products, pricing, financial performance, distribution, regulatory compliance, and legislative issues. Interpret rating regulations.
i. Provide information to internal stakeholders in the areas of trends and rating decisions to aid in sales and retention and impact of provider contracts on pricing and experience by product.
j. Consult with various departments such as Rating & Underwriting, Healthcare Informatics, Network Management, Product Development, Provider Contracting, Corporate Communications, Financial Reporting, Compliance and others as needed on various initiatives.
k. Prepare and maintain documentation related to standard operating procedures as well as routine and special projects.
l. Serve as a subject matter resource for corporate or departmental process improvement initiatives, involving designing, adjusting, and documenting work processes workflow to ensure that predictable and replicable success is achieved through best practice. Adopt a whole system view in evaluating and improving the sequence and content of work activities to optimize process effectiveness and integrity.
m. Provide benefit cost information for various legislative initiatives. Provide technical input on changes to new and existing regulations and rules. Interpret how regulatory and legislative changes may affect business and develop impact analyses.
n. Other duties as assigned.
An Equal Opportunity Employer
The policy of Wellmark Blue Cross Blue Shield is to recruit, hire, train and promote individuals in all job classifications without regard to race, color, religion, sex, national origin, age, veteran status, disability, sexual orientation, gender identity or any other characteristic protected by law.
Applicants requiring a reasonable accommodation due to a disability at any stage of the employment application process should contact us at [email protected]
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