Remote opportunity for residents of Colorado, Illinois, Kentucky, Ohio, Pennsylvania, South Carolina, Texas, Utah, Virginia, Washington, and Wisconsin.
Job Summary
Directs the activity of the organization’s actuarial and medical economics. Manage internal and external teams of actuaries and analysts to complete rate filings, analysis of the local healthcare landscape, help increase risk adjustment capture and aid product teams in benefit design analysis. Director provides coaching, training, and support to direct reports and works collaboratively to educate other departments when necessary. Works with the analytics team to ensure data accuracy for rate filings and has a firm understanding of healthcare data complexity. Keeps track of the regulatory environment across multiple product lines in conjunction with the product teams to ensure that elements that might affect pricing, network strategy, and risk adjustment are considered when filing rates. Works collaboratively with the risk adjustment department to achieve alignment between rate setting and risk adjustment initiatives. Suggests strategic initiatives to lower healthcare costs, maintain quality and generate risk adjustment opportunities.
Responsibilities
1. Lead the development of product pricing and reserves for various health insurance products.
2. Conduct analysis and make recommendations on rate changes, product design, and medical management policies based on data-driven insights
3. Review and analyze trends in healthcare utilization, cost, and quality to identify opportunities for cost containment through contracting or care management activities.
4. Manage the budget and resources of the actuarial, medical economics teams to ensure efficient and effective operation.
5. Collaborate with numerous departments to develop company-wide policies and procedures related to actuarial, medical economics and risk adjustment functions.
6. All other duties as assigned.
Education and Experience
1. Bachelor’s degree in Economics, Statistics, Computer Science, Business, Public Health, Epidemiology, Mathematics, Risk Management, Actuarial Science, Data Analytics or related quantitative discipline required.
2. 10+ years of progressive Health Insurance Experience required.
3. Direct experience with both MA and ACA risk adjustment required
4. Familiar with all aspects of Medicare Advantage and ACA actuarial entries
5. Previous experience in Health/Medical Economics preferred.
Knowledge, Skills and Abilities
1. Knowledge of health care administration, including managed care, Medicaid, Medicare, Exchange and CHP+.
2. Knowledge of STARs and Risk Adjustment required.
3. Skilled in analytical thinking, problem solving, and process improvement.
4. Ability to grow and develop strong teams from scratch.
5. Ability to simultaneously coordinate and manage several functions, programs, and projects in various stages of completion.
Computers and Technology
1. Intermediate to Advanced Excel skills.
2. Experience with SQL and Tableau.
Certificates, Licenses and Registration
1. Associate of the Society of Actuaries or Fellow of the Society of Actuaries (ASA or FSA) certification required.
Supervisory Responsibilities
1. This position will be responsible for, but not limited to, hiring, terminating, performance management, coaching, supervision, fostering teamwork, training and development of one or more employees.
Location
Denver Health Medical Plan
Shift
Days
Work Type
Full time
Salary:
$158,000.00 - $244,800.00/yr
All job applicants for safety-sensitive positions must pass a pre-employment drug test, once a conditional offer of employment has been made.
Denver Health is an integrated, high-quality academic health care system considered a model for the nation that includes a Level I Trauma Center, a 555-bed acute care medical center, Denver’s 911 emergency medical response system, 10 family health centers, 18 school-based health centers, Rocky Mountain Poison and Safety, a Public Health department, an HMO and The Denver Health Foundation.
As Colorado’s primary, and essential, safety-net institution, Denver Health is a mission-driven organization that has provided billions in uncompensated care for the uninsured. Denver Health is viewed as an Anchor Institution for the community, focusing on hiring and purchasing locally as applicable, serving as a pillar for community needs, and caring for more than 185,000 individuals and 67,000 children a year.
Located near downtown Denver, Denver Health is just minutes away from many of the cultural and recreational activities Denver has to offer.
We strongly support diversity in the workforce and Denver Health is an equal opportunity employer (EOE).
Denver Health is committed to provide equal treatment and equal employment opportunities to all applicants and employees. As an EOE, Denver Health does not discriminate against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity, status as a veteran, and basis of disability or any other federal, state or local protected class.
caminobluff.com is the go-to platform for job seekers looking for the best job postings from around the web. With a focus on quality, the platform guarantees that all job postings are from reliable sources and are up-to-date. It also offers a variety of tools to help users find the perfect job for them, such as searching by location and filtering by industry. Furthermore, caminobluff.com provides helpful resources like resume tips and career advice to give job seekers an edge in their search. With its commitment to quality and user-friendliness, Site.com is the ideal place to find your next job.