Actuarial Analyst PD III

Job Description

Job Description

JOB DESCRIPTION

JOB TITLE: Actuarial Analyst III FLSA STATUS: Exempt

DEPARTMENT: Actuarial Services

REPORTS TO: Senior Director, Actuarial Services

JOB SUMMARY: This role will work closely with the lead actuary to help them support pharmacy reporting. Must have extensive working experience working with pharmacy claims. In addition to technical data concepts, must have the desire to learn and be able to conduct detailed analysis and provide results. Is responsible for managing reporting projects to ensure that data and analysis requests are completed timely, accurately to meet the needs of the pharmacy department.

ESSENTIAL JOB FUNCTIONS:

1. Support analysis for the actuarial department and finance teams.
2. Key tasks include supporting engagements with outside venders. Vendor engagements include pricing work, risk score initiatives, and quality measures.
3. Periodic utilization and cost reporting.
4. Support the revenue cycle.
5. Support efforts towards consolidating data management and creating dashboards.
6. Automate processes and improve efficiency using tools such as SQL, Power BI, and Excel.
7. Ensure data accuracy, integrity, and documentation of methodologies.
8. Manage assigned projects and effectively communicate with the requestor and leadership team any project roadblocks that may jeopardize deadlines in advance of due dates.
9. Responsible for understanding the various data sources available at Imperial.
10. Document all coding/analysis/reporting projects following established protocols to ensure transparency and repeatability.
11. Collaborates and maintains effective working relationships with management, internal departments, and external vendors.
12. Work with management to prioritize business and information needs.
13. Maintains regular and consistent attendance.
14. Adheres to Compliance Plan and HIPAA regulations.

MARGINAL JOB FUNCTIONS:

1. Takes on special projects as needed.
2. Performs other duties as assigned.

BEHAVIORAL EXPECTATIONS:

1. Continuous Learning:

a. Attends staff meetings as required.

b. Attends appropriate training, seminars and workshops as required.

2. Customer Focus:

a. Maintains client/customer confidentiality and privacy in accordance with HIPPA regulations

and IMAS’s Standards of Conduct.

b. Fosters appropriate communication and relations with Supervisor, co-workers and other staff.

3. Quality/Process Improvement/Safety:

a. Reports issues of security, health and/or safety to related supervisors as soon as practicable.

b. Supports and demonstrates safety throughout all duties performed.

c. Follows established policies and procedures and understands and complies with all regulators

standards set forth by governing entities.

POSITION REQUIREMENTS:

EDUCATION/EXPERIENCE:

• Bachelor’s degree in Actuarial Science, Mathematics, Statistics, Economics, or related field.
• Four or more years of experience in a healthcare or related setting (Preferably Medicare Advantage, Medicaid, Commercial insurance)
• Must have experience in SQL, Power BI, and Excel. All other languages and platforms are a bonus.
• Must have at least four exams and actively pursuing exams through the Society of Actuaries.
• 4+ years of experience with SQL reporting and analytics with data analysis, extraction, and manipulation.
• 4+ years designing reports and developing executive level presentations.
• 4+ years experience in healthcare (Medicare Advantage, Medicaid, Exchange/ACA Markets).

SKILLS/KNOWLEDGE/ABILITY:

• Thorough knowledge of MS Office Suite particularly Excel.
• Outstanding organizational and problem-solving aptitude, solution oriented and willingness to dig into the details
• Willingness and ability to read, write, speak, understand English and have the communications skills necessary to provide accurate information to members and staff.
• Willingness and ability to follow written and verbal direction in English.
• Willingness and ability to maintain an appropriate level of confidentiality and privacy.
• Willingness and ability to interact professionally with all customers, members, and co-workers, individually and as part of a team.
• Willingness and ability to effectively handle multiple items/tasks as required and adapt favorably to changing priorities.
• Willingness and ability to make appropriate judgments, decisions and problem solving in a timely manner and within the context of the situation at hand.
• Ability to effectively prioritize items/tasks as required.
• Willingness and ability to take initiative and be a self-starter.
• Willingness and ability to understand and comply with Federal, State, and local regulations.

LICENSURE/CERTIFICATE/TRAINING:

• Must be actively pursuing exams under the Society of Actuaries