Managing Actuary, Value-Based Contract Analytics

Role Description

Shape the world of health care by joining UPMC! As a leader in the industry, we are committed to enhancing the lives of all who are a part of our community. Without our employees, we would not be able to innovate health care for our patients and health plan members. To continue our tradition of excellence, we are in search of a full-time Managing Actuary.

The Department of Health Economics is seeking a Managing Actuary! This credentialed healthcare actuary would drive high-visibility impactful analysis and would be responsible for developing and driving medical cost improvement strategies for UPMC Health Plan in collaboration with leadership.

• Develop and evaluate financial outcomes of value-based contracts.
• Analyze medical cost utilization and unit cost data.
• Identify top trend drivers of contract performance.
• Develop strategies across cross-functional teams such as Network, Actuarial, Finance, and Clinical.
• Support the execution of those strategies.
• Supervise 2-3 supporting staff, including actuarial analysts.

This position is a work-from-home position located anywhere within the continental US.

Responsibilities

• Partner with Health Plan senior leadership for creative problem-solving and strategic decision-making involving medical cost improvement strategies.
• Direct a team to produce detailed actuarial and financial models which communicate near and long-term projections of financial performance of value-based provider reimbursement contracts.
• Forecast and interpret financial results of value-based contracts, including variances from budget.
• Develop healthcare claims cost and utilization trends for use in projections defining savings methodologies for provider arrangements.
• Develop and gain support for data-based recommendations with team members from product, clinical, network, and strategy functions.
• Bring clarity to complex problems using exceptional communication skills when engaging with senior leadership and technical audiences.
• Apply an understanding of complex actuarial concepts, methods, and applications in a variety of situations.
• Creatively leverage a wide range of datasets to inform key analyses.
• Build strong relationships within cross-functional workgroups including Network, Pharmacy, Actuarial, Analytics, and Finance teams.
• Ensure that departmental work products meet the highest standards of quality.
• Manage and develop a team of 2-3 supporting staff including actuarial analysts.

Qualifications

• Bachelor's degree in mathematics, statistics, actuarial science, economics, or related field required; advanced degree preferred.
• ASA certification by Society of Actuaries required; FSA preferred.
• 6.5 years of experience in progressively more responsible actuarial work in health insurance/managed care or equivalent training/education.
• Experience in development and settlement of value-based provider contracts, network and reimbursement methodology analysis, claims-based experience analysis, trend analysis is a strong preference.
• Experience with commercial and government health programs preferred.
• In-depth understanding of health insurance market dynamics.
• Excellent problem-solving and analytical skills.
• Good oral and written communication skills.
• Adaptability and ability to prioritize effectively.
• Strong PC skills.
• Data retrieval skills and relational database experience.
• Management experience preferred.

Licensure, Certifications, and Clearances

• ASA or FSA certification by Society of Actuaries required.
• Membership in the American Academy of Actuaries required.