Actuary

UPMC Health Plan in Pittsburgh, PA seeks multiple Actuaries to design and develop value-based contract project work, and determine the performance measures, associated benchmarks, and other contractual components. Analyze membership, risk score, claim and other available internal and external data, monitor emerging trends, and identify issues. Analyze and create ACO contracts, PCMH arrangements, Global Capitation, Bundled Rates, Episodic Payments, Capitation, Risk Adjusted Total Cost of Care, and Value Based Payments. Build credibility and trust, enhance contract risk assessment, monitor changes to the risk profile, risk analytics, and understand key drivers. Present and explain results of actuarial analyses to advise UPMCHP management on the financial impact of proposed provider agreements or changes to existing agreements on an as-needed basis. Develop and maintain actuarial project work plans, including critical tasks, milestones, timelines, interdependencies, and contingencies. Track and report progress to the department management and keep stakeholders appraised of project status and implications for completion. Performs in accordance with system-wide competencies/behaviors.

Job Responsibilities:

• Design and develop value-based contract project work, and determine the performance measures, associated benchmarks, and other contractual components.
• Analyze membership, risk score, claim and other available internal and external data, monitor emerging trends, and identify issues.
• Analyze and create ACO contracts, PCMH arrangements, Global Capitation, Bundled Rates, Episodic Payments, Capitation, Risk Adjusted Total Cost of Care, and Value Based Payments.
• Build credibility and trust, enhance contract risk assessment, monitor changes to the risk profile, risk analytics, and understand key drivers.
• Present and explain results of actuarial analyses to advise UPMCHP management on the financial impact of proposed provider agreements or changes to existing agreements on an as-needed basis.
• Develop and maintain actuarial project work plans, including critical tasks, milestones, timelines, interdependencies, and contingencies.
• Track and report progress to the department management and keep stakeholders appraised of project status and implications for completion.
• Performs in accordance with system-wide competencies/behaviors.

Qualifications:

• Master's degree, or equivalent, in Actuarial Science, Mathematics, Statistics, Economics, or related field.
• Two (2) years of actuarial experience in health insurance/managed care, actuarial consulting to health actuaries, or related experience:
  Leading attribution and trumping logic for total cost of care based VBP
  contracts;
• Developing annual targets and benchmarks based on internal and external data;
• Developing risk scores, risk adjusted revenue and claim cost projections;
• Leading deep-dive analyses and presenting findings and recommendations to senior management;
• Working with and applying knowledge in Medicare Advantage Risk Adjustment Modeling;
• Utilizing programming languages, tools, and technologies including: SQL and/or SAS, and Excel including VBA.
• Must hold ASA or FSA certification by Society of Actuaries
• Must hold membership in the American Academy of Actuaries.

Telecommuting permissible