Actuary, Senior

Actuary, Senior This senior level position is responsible for performing a wide variety of financial and actuarial analyses impacting strategic decision‑making and the company's financial sustainability efforts. The role covers 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. Estimated Hiring Range: $138,150.00 - $168,850.00. Bonus Target: Bonus - SIP Target, 5% Annual. Essential Responsibilities Perform financial and actuarial analyses impacting strategic decision‑making and financial sustainability. 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. Design, develop, and implement evaluation tools to measure the effectiveness of programs and payment models. Develop cost savings calculators for goal setting, budgeting, and forecasting. Provide rate‑setting support through data analysis, policy review, and strategy development. Identify actuarial unsound adjustments to rates. Provide medical cost and utilization trend recommendations for forecasting purposes. Gather and develop benchmarks to assess performance and identify improvement opportunities. Monitor risk adjustment applied to capitation revenue and ensure population risk is appropriately represented in encounter data. Evaluate provider payment models, including risk‑share arrangements, to achieve desired outcomes. Prepare risk‑share reporting for providers and support accounting estimates. Drive strategic use of data to support business efficiencies and competitive decision‑making. Review and provide guidance on actuarial estimates such as IBNR and PDR. Coordinate and review outside actuaries' work to facilitate access to plan information and protect company interests. Provide training and support to other finance users around data, software, and analytic approaches. Work with Information Systems to ensure data sources have high integrity. Collaborate with Business Intelligence and other analysts to share best practices, maintain data governance, and build a community of practice. Train, mentor, and evaluate performance of assigned actuarial staff. Experience and/or Education Required Associate of the Society of Actuaries. Minimum 5 years of experience in an actuarial role. Work experience in health insurance. Preferred: Fellow of the Society of Actuaries. Preferred: Work experience in Medicaid or Medicare. Knowledge, Skills, and Abilities Required Knowledge of Microsoft Office products and MS Access. Understanding of data systems and sources and their impact on data availability. Knowledge of medical claims, billing practices, and health insurance requirements. Strong data management skills. Proficiency in SAS, SQL, or similar database querying tools. Proficiency in MS Excel. Highly effective communication skills, including listening, verbal, and written. Willingness to acquire new skills. Ability to lead large projects across departments. Ability to identify, implement, and lead process improvements. Strong ability to articulate and present information across multiple areas of the organization. Ability to communicate and present to external parties and stakeholders. Ability to collaborate effectively with department management and coworkers. Strong attention to detail and accuracy. Ability to produce high‑quality output and review others’ work. Ability to identify problems, inconsistencies, unforeseen results, and uncertainties. Ability to interpret and analyze information and implement conclusions/solutions. Ability to assist team members in developing conclusions and solutions. Ability to prioritize own work and complete tasks on time. Ability to embrace change. Ability to maintain a positive attitude. Ability to work effectively with diverse individuals and groups. Ability to focus, understand, evaluate information, and determine appropriate actions. Ability to accept direction and feedback, and manage stress. Physical requirement: repetitive finger and wrist movement for at least 6 hours per day. Physical requirement: hearing and speaking clearly for at least 3-6 hours per day. Working Conditions Work environment: Indoor/Office. Member/patient facing: No. Hazards may include physical and ergonomic hazards. Equipment: General office equipment. Travel may be occasional, required or optional, outside the workplace; personal vehicle or local transit may be used. Work location: Work from home. Benefits Competitive pay, bonus opportunity, and a comprehensive benefits package. Eligibility for bonuses and benefits depends on position type and scheduled weekly hours. Benefits‑eligible employees qualify for benefits beginning on the first of the month on or after their start date. Medical, dental, vision, life, AD&D, disability insurance; health savings account; flexible spending account(s); lifestyle spending account; employee assistance program; wellness program; discounts; and supplemental benefits (voluntary life, critical illness, accident, hospital indemnity, identity theft protection, pre‑tax parking, pet insurance, 529). Strong retirement plan with employer contributions. Benefits‑eligible employees accrue PTO and paid state sick time based on hours worked/scheduled hours and primary state. Employees may also receive paid holidays, volunteer time, jury duty, bereavement leave. Non‑benefits eligible employees can receive 401(k) contributions, paid state sick time, wellness and employee assistance program benefits, and other perks. Contact recruiter for more information. CareOregon is an equal opportunity employer. The organization selects the best individual for the job based upon job‑related qualifications, regardless of race, color, religion, sexual orientation, national origin, gender, gender identity, gender expression, genetic information, age, veteran status, ancestry, marital status, or disability. The organization will make a reasonable accommodation to known physical or mental limitations of a qualified applicant or employee with a disability unless the accommodation will impose an undue hardship on the operation of the organization. #J-18808-Ljbffr