Assesses risk of new Medicare Advantage, Full Risk, and Value-Based contracts
Develops underwriting policies
Assists with setting targets in the payor contracting process
Calculates trends and projections for Medicare Advantage, Full Risk, and Value-Based contracts
Develops and/or evaluates predictive models that will determine members with rising risk that would be candidates for care management intervention
Develops models and health outcomes ROI analyses to evaluate cost improvement, quality improvement, and care management projects and programs
Develop and improve IBNR models on an ongoing basis
Builds strong relationships with leadership, customers, and peers. Communicates appropriately and effectively with stakeholders, customers and supervisors, maintaining awareness of any issues, potential delays, and any situation of concern that may affect the productivity of supported programs, processes and systems
Work collaboratively to prioritize work to meet contractual goals
Perform other duties as assigned to ensure smooth and efficient operations of the organization.
What You Will Need:
Bachelors Degree in Actuarial Science, Mathematics, Statistics, Economics, Finance, or related field
Minimum 10 to 15 years of actuarial related experience in a health plan, healthcare consulting, or population health organization
ASA (Associate of the Society of Actuaries) Designation, or equivalent
Experience with Medicare products, including Medicare Advantage and the Medicare Shared Savings Program
Experience with state Medicaid programs
Experience with Individual and Group Exchange Benefit Plans
Experience with Risk Adjustment programs
Knowledge of the financial structure and processes of Value Based Payment and ACO models
Excellent analytical, problem solving, prioritization and operational skills
Excellent verbal and written communication skills
High-level interpersonal skills. Able to work collaboratively and tactfully with multi-disciplinary and diverse teams that may include senior executives, employees, and customers
Effective computer skills, particularly Microsoft Office Outlook, Word, Power Point and Excel
The Actuarial Consultant is responsible for assisting leadership in providing strategic and technical services related to risk assessment, underwriting, projections, predictive modeling, and health outcomes analysis. The Actuarial Consultant will assess risk of new and existing contracts and make recommendations as how to mitigate that risk as well as to develop underwriting policies. The Actuarial Consultant is responsible for developing predictive models that will assist with member intervention and be able to evaluate the value of those models and programs.
The Actuarial Consultant will be experienced with Medicare products, including Medicare Advantage and the Medicare Shared Savings Program. Also, the Actuarial Consultant will have a good knowledge of Value-Based financial models.
AdventHealth Greater Orlando (formerly Florida Hospital) is one of the largest faith-based health care providers in the United States. For 150 years, we have carried on a tradition of providing whole-person care that not only addresses patients' physical ailments, but also supports their emotional and spiritual well-being. We demonstrate the same level of compassion and care for our employees as well, doing all that we can to help them realize their full potential – both personally and professionally.
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