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Univera Healthcare · 9 hours ago

Team Leader, Actuarial Services Encounter Data

Buffalo, NY

Full-time

Hybrid

Mid, Senior Level

$98K/yr - $177K/yr

5+ years exp

Univera Healthcare is seeking a Team Leader for their Actuarial Services department. This role involves overseeing a team that provides financial projections and actuarial analyses, managing deliverables and timelines, and ensuring compliance with regulatory requirements.

Health CareInsuranceMedicalNon Profit

Comp. & Benefits

Responsibilities

Supervises direct staff projects, manages deliverables and timelines, and reviews results and delivers feedback to support business objectives and analyst development

Establishes individual annual performance goals for staff, guide staff in setting individual learning and development plans, assess individual performance, and determine merit, promotional and recognition salary increases and awards

Recommends reserves for blocks of business and in total. Initiates and organizes analyses to support recommendations

Leads preparation and submission of NAIC and NYS financial blanks

Leads preparation and submission of Regulation 146 and Direct Pay Stop Loss reports to the NYS Insurance Department

Manages and develops financial plans, forecasts, and other financial projections including risk sharing, reinsurance liabilities, revenues, and Medicare bid pricing

Supervises the submission and quality of NYS and CMS regulatory encounter submissions and supports all required audits, internal and external to ensure accuracy. Supervises reporting, valuation, and forecasting of risk adjustment score and revenues to support partners internal and external, including providers and vendors

Prepares, or obtains externally, actuarial statements of opinion for rate and product filings and financial statements for assigned business segments

Recommends regional or product line profitability targets; ensure pricing is consistent with established targets for those business segments priced in actuarial

Develops and maintains rates, rating factors and rate filings. Develop and maintain rating methods and models

Monitors and analyzes trends; develop trend projections and seasonality factors

Ensures proper drug claim adjudication and reporting

Provides input into product development process

Projects risk adjustment factors, model impacts of potential payment changes

Provides revenue forecasts for pro forma and bid pricing

Manages annual loss ratio testing and reporting process

Ensures efficient use of SAS software in the development of data sets and models

Monitors budget vs. actual financial results, conduct analysis of variance, and prepare variance summary

Reconciles Data Warehouse data with corporate financials. Notifies Information Management with regard to Data Warehouse integrity issues

Identifies opportunities for automation in processes

Represents the actuarial department in meetings and communications with NYSID, CMS, BCBSA, rating agencies, consultants, customers and other external parties

Prepares and maintains documentation for routine procedures and special projects

Participates in corporate or departmental process improvement initiatives that involve designing, adjusting, and documenting work processes to ensure that predictable and replicable success is achieved through best practice

Identifies non-actuarial functional work occurring within actuarial or actuarial functional work occurring outside actuarial and initiates/supports corrective functional transition plans

Oversees the design and development of Actuarial data extracts, marts and warehouses

Proposes and assists in development of Actuarial process improvements utilizing SAS or other analytical software

Consistently demonstrates high standards of integrity by supporting the Lifetime Healthcare Companies’ mission and values and adhering to the Corporate Code of Conduct

Maintains high regard for member privacy in accordance with the corporate privacy policies and procedures

Maintains knowledge of all relevant legislative and regulatory mandates and ensures that all activities are in compliance with these requirements

Conducts periodic staff meetings to include timely distribution and education related to departmental and Ethics/Compliance information

Regular and reliable attendance is expected and required

Performs other functions as assigned by management

Qualification

SASActuarial scienceFinancial projectionsData analysisMicrosoft OfficeSQLRPythonProcess improvementAnalytical skillsLeadershipCommunication skills

Required

Five (5) years of actuarial or related insurance industry experience

Bachelor's degree in math, economics, actuarial science, or related field

Ability to understand and work with programming languages similar to SAS, SQL, R, Python, C/++/#, VB, etc

Advanced analytical skills

Advanced knowledge of financial and health risk arrangements

Prior experience supervising or managing people and/or projects or indirectly leading teams

Strong skills including proficiency in Microsoft Office, SAS, Cognos or related software

Strong verbal and written communication skills with the ability to present clear and concise information to all audiences

Ability to design and implement process improvements

Ability to translate technical concepts into business language

A thorough understanding of non-Actuarial functions such as Rating & Underwriting, Finance, Provider Contracting, Network Management, Product Development, Medical Management, Marketing & Sales, etc. and how they impact Health Plan operations, financials and forecasts