Consultant

Job Title

Job Requirements

Position Summary: To be fully engaged in providing Quality/No Harm, Customer Experience, and Financial Stewardship through statistical data analysis/support and construct probability tables to forecast risk and liability. Support product rate filings, reserve calculations, group underwriting and experience reporting to make product pricing decisions. Support the financial management of the health plan through medical cost and revenue projections predominantly through the use of Excel and SQL. Explain complex technical matters as needed.

Primary Accountabilities

• Engagement: Represent the System as necessary through community activities and participation in professional organizations.
• Quality/No Harm: Support and developed financial models for the monitoring and projection of current and future business. Maintain rating models and data base support programs used in the Underwriting department. Develop and maintain models for the calculation of appropriate claims and other reserves. Submit weekly report showing progress on current projects.
• Customer Experience: Demonstrate dependability, flexibility and a high level of job interest. Consistently seek ways to improve operational and financial efficiencies through better use of resources. Contribute to development and maintenance of management reports necessary for the financial management of all products.
• Stewardship: Support the development of required state and federal premium rate and other filings. Assist in development and pricing of new products and product enhancements, including development of provider payment mechanisms. Assist in the determination of premium rates required and cash reserves necessary to ensure payment of future benefits. Support the design, review, and administration of health insurance plans, determine financial soundness and calculation of premiums. Collaborate with Decision Support, Underwriters, Claims, and Senior Management to develop plans for new lines of business or improve existing business.

Work Experience

Minimum Qualifications

• Education: BS or BA degree in Mathematics, Actuarial Science or related major from an accredited college or university or currently enrolled as a student majoring in one of the aforementioned programs.
• Education: 3.0 GPA in college or university or successfully passed one exam; 3.4 GPA preferred.
• Knowledge/Skills/Abilities: Sat for at least one actuarial exam. Knowledge of laws, government regulations, and agency rules for managed care controls. Some level of understanding of insurance and associated terminology. Strong background in arithmetic, algebra, geometry, calculus, statistics, and their applications. Knowledge of economics and accounting principles and practices and reporting of financial data. Knowledge of document structure and content, including spelling, grammar and rules of composition.

Physical Requirements

• Able to sit and view computer screen for up to three hours at a time to enter data and set up functions.
• Ability to work extended hours as projects demand.
• Ability to occasionally stand; walk; use hands to handle or feel; and reach with hands and arms.
• Able to frequently lift and/or move up to 25 pounds.

Mental Demands

• Able to work in often stressful environments and maintain composure.
• Must exhibit superior analytical and problem-solving abilities, to compile, categorize, and verify information.
• Ability to prioritize and organize to maximize quality, value, and service.

About Health First

At Health First, diversity and inclusion are essential for our continued growth and evolution. Working together, we strive to build and nurture a culture that recognizes, encourages, and respects the diverse voices of our associates. We know through experience that different ideas, perspectives, and backgrounds create a stronger and more collaborative work environment that delivers better results. As an organization, it fuels our innovation and connects us closer to our associates, customers, and the communities we serve.

Schedule: Per Diem

Shift Times: 8:00am-5:00pm

Paygrade: PG-22