This position works with a team of analysts and actuaries to support premium rate setting, provider contract analysis, network analysis, Medicare bid submissions, underwriting and other financial risks associated with health insurance. The Risk Analyst IV provides basic and complex analysis of business strategies, and may be asked to maintain or build models to support their work.
- Analyze performance of line of business / account / provider: Assess overall LOB/account risk including competitive analysis, broker behavior, network cost profile, legislative and regulatory impacts, payer goals and contributions. Build reports and provide analysis that provide clear, actionable information to clients and/or the organization. Obtain adequate peer review of own work, and provide review for the work of others.
- Assumption setting for line of business / account / provider: Set assumptions and/or make decisions that establish appropriate risk positions for the organization; may impact revenue or allowed claims cost of up to $10 million. Develop supportive factors and/or adjustments based on credible experience. Collect and evaluate data for rating and management purposes. Evaluate changes in provider network, including provider compensation, scope or utilization changes, for trend-setting activities. Collaborate with Sales, Product Development, and/or Provider Services on rate negotiations.
- Development of Actuarial Tools and Data Resources: Create and maintain models (such as rate model and benefit pricing tools) that support the analysis of business strategy and financial risk management. Document models, tools, assumptions and data elements as necessary for compliance and continuity.
- Minimum seven (7) years of related business/financial experience.
- Excellent SQL Skills
- Familiarity with multiple DBMS
- Experience developing ETL processes using SAS
- Comfortable in a UNIX environment
- Strong focus on efficiency and data quality
- Medicare & ACA knowledge
- Bachelor's degree in business administration, finance, mathematics, actuarial science or related fields OR a minimum four (4) years of experience in a directly related field.
- High School Diploma OR General Education Development (GED) is required.
License, Certification, Registration
- Responsible for deploying underwriting/actuarial techniques and knowledge to make appropriate rate decisions that can impact up to $5 million in revenue or claims.
- Demonstrated working knowledge and skills in the analysis of health-care claims data and other related cost; Demonstrated knowledge in analysis of member, purchase, and provider contracting.
- Excellent verbal, written and presentation communication skills; Excellent customer service and organizational skills.
- Expertise in financial and risk modeling.
- Demonstrated ability to apply actuarial and underwriting principles in day-to-day problems.
- Ability to develop and apply tactics to achieve organizational business strategy.
- Ability to identify and solve problems.
- Demonstrated understanding of insurance principles.
- Demonstrated working knowledge and skills in financial modeling; Familiarity of financial transaction flow within operational and financial systems.
- Proficient in Microsoft Office applications.
- Eight (8) years of related business/financial experience.
- Bachelor's degree in business administration, finance, mathematics, actuarial science or related fields.