Senior Actuarial Analyst (Pharmacy)

Actuarial Analyst

EmblemHealth

REMOTE

Summary:

Identify opportunities to reduce medical expenses and collaborate with other areas to implement and monitor performance. Participate in product development, pricing, filing, and rating implementation of new products and strategies. Develop studies, analyses, and presentation materials needed to appropriately inform decision makers. Answer questions of less experienced staff.

Responsibilities:

• Analyze and understand hospital, professional, and drug claim/utilization trends, membership/demographics, and financial variance to budget, and performs various other ad-hoc analyses.
• Maintain appropriate controls around models and other work products.
• Ensure quality and on time completion of deliverables.
• Provide support for coordination of quarterly close activities.
• Partner with key stakeholders to develop and finalize valuation methodologies.
• Prepare and analyze results and forecasts.
• Perform monitoring processes for trends and risk valuation calculations.
• Develop efficient and transparent queries to obtain data that is appropriate to the purpose with minimal assistance and oversight.
• Make appropriate recommendations to management across teams within the actuarial department.
• Proactively ensure the internal and external consistency of all work.
• Perform reasonability checks dependent on industry knowledge and experience.
• Develop and implement analyses for special projects.
• Provide technical and analytical support for both the Actuarial department and internal partners.
• Proactively take on additional work as needed by the team.
• Perform duties and assignments as directed or required.

Qualifications:

Education, Training, Licenses, Certifications

• Bachelor's degree in Actuarial Science, Mathematics, other physical science, or related finance/business degree required
• Associate of the Society of Actuaries required

Relevant Work Experience, Knowledge, Skills, and Abilities

• 4 - 6+ years of relevant, professional work experience and/or education required
• 1 - 2+ years health insurance actuarial experience, preferably in the managed care industry required
• Must make sufficient progress toward obtaining actuarial credentials, defined as sitting for a minimum of one exam per year, scoring above a zero, and obtaining at least a combined score of 5 over two consecutive sittings
• When unable to meet the progress outlined in the bullet above, the role will be transitioned to a non-Actuarial job title and job description
• Comprehensive understanding of actuarial principles and methodologies and strong mathematical and analytical skills required
• Excellent communication skills (verbal, written, presentation) required
• Strong working knowledge of MS Office including Outlook, Word, Excel, PowerPoint, etc. required
• Working knowledge of SQL, R, Python or similar required
• Capable with Excel, data extraction, simulations, automation required
• Knowledge of reimbursement methodologies required