Lead Actuary

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Job Summary:

This senior-level position is responsible for leading and performing a wide variety of financial and actuarial analyses impacting strategic decision-making and the company’s financial sustainability efforts. Areas of analysis include cost and utilization trend analysis, return on investment evaluations, Medicare bid development, rate setting optimization, forecasting support, benchmarking, risk adjustment optimization, provider payment evaluation, and review of actuarial estimates such as IBNR and PDR. This position provides financial stewardship by identifying opportunities for improved financial performance and working collaboratively with other departments to socialize, communicate and inform decision making.

Financial and Actuarial Analyses:

• Drill down into cost and utilization trends to identify key drivers.
• Develop profitability analytics to support evaluation by provider group, contract, and other valued indicators.
• Lead the design, development, and implementation of evaluation tools in measuring the effectiveness of programs and payment models.
• Develop cost savings calculators for use in goal setting, budgeting, and forecasting
• Provide rate-setting support through data analysis, policy review, and strategy development.
• Identify any actuarial unsound adjustments to the rates.
• Provide medical cost and utilization trend recommendations for forecasting purposes.
• Gather and develop benchmarks for purposes of assessing our performance and the potential for improvement.
• Monitor risk adjustment applied to capitation revenue and ensure population risk is appropriately represented in encounter data.
• Develop and evaluate provider payment models, including risk share arrangements, to ensure they achieve the desired outcome.
• Prepare regular risk share reporting for sharing with providers and supporting accounting estimates.
• Drive strategic use of data to support business efficiencies and competitive decision-making.
• Review and provide guidance on actuarial estimates of IBNR, PDR, and other actuarially determining assets and liabilities.
• Coordinate and review the work of outside actuaries to facilitate access to plan information necessary to support their work and ensure the company’s interests are represented.

Financial Analytical Capacity and Capability:

• Work with Information Systems to ensure access to a data source with high data integrity.
• Work collaboratively with the Business Intelligence department and other analysts to share best practices around using the data, ensure strong data governance and maintain a community of practice resources.
• Provide training and support to other Finance users around the data, software, and analytic approaches.

Administration:

• Participate in 1:1, team, and department meetings; Attend All Staff meetings.
• May participate in broader, functional discussions and initiatives across Finance Department.
• Draft, recommend, and implement plans, policies, and procedures; participate in Actuarial Services team goal setting.

Team Leadership:

• Provides leadership for a team in support of team direction and goals.
• Provides input into staffing needs; assists in recruiting and hiring staff, using an equity, diversity, and inclusion lens.
• Participates in organizing, scheduling, monitoring, and improving work; helps ensure employees have information to meet job expectations and have coverage during absences.
• Contributes to the development, communication, and oversight of team and individual goals.
• Trains, leads, and coaches employees; may facilitate team meetings.
• Incorporates guidance from provider equity tools into people leadership.
• Helps monitor employee adherence to department and organizational standards, policies, and procedures.
• Assists in evaluating employee performance, providing feedback to support success, recognizing strong performance, and addressing performance gaps and accountability (corrective action).
• Performs lead tasks in collaboration with Human Resources as needed.

Organizational Responsibilities:

• Perform work in alignment with the organization’s mission, vision, and values.
• Support the organization’s commitment to equity, diversity, and inclusion by fostering a culture of open-mindedness, cultural awareness, compassion, and respect for all individuals.
• Strive to meet annual business goals in support of the organization’s strategic goals.
• Adhere to the organization’s policies, procedures, and other relevant compliance needs.
• Perform other duties as needed.

Technical:

• Strong data management skills
• Proficiency in SAS, SQL, or similar database querying tools
• Proficiency in MS Excel
• Working knowledge of other MS tools, including MS Office products, MS Access
• Strong understanding of data systems and sources and how it impacts the data available
• Knowledge of medical claims, billing practices, and health insurance requirements
• Ability to effectively lead and participate in a variety of large projects, including complex initiatives across departments
• Ability to identify, implement, and lead process improvements

“Careers and companies flourish when staff, clients, and candidates truly believe in the mission, know the role they play, and humbly reflect, evaluate, and act for the best interest of the communities served".

"Careers and companies flourish when staff, clients, and candidates truly believe in the mission, know the role they play, and humbly reflect, evaluate, and act for the best interest of the communities served".

Job Type: Full-time

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Employee discount
• Flexible schedule
• Flexible spending account
• Health insurance
• Health savings account
• Life insurance
• Paid time off
• Relocation assistance
• Retirement plan
• Vision insurance

Physical Setting:

• Office

Schedule:

• Monday to Friday
• Weekend availability

Ability to commute/relocate:

• Portland, OR: Reliably commute or planning to relocate before starting work (Preferred)

Experience:

• SQL: 1 year (Preferred)

Work Location: One location