Risk Analytics Actuary

The Risk Analytics Actuary is a key position reporting to the Senior Financial Controller. This role is highly visible to the CEO and Senior Leadership Team. The Risk Analytics Actuary has responsibility for three key areas:

  1. Reviewing and researching Medical Cost trends, highlighting and identifying issues and then working with Management to address these issues.
  2. Supporting the development of Value Based Contracts with Independence Blue Cross and with forward thinking Providers.
  3. Supporting the development of the Annual Financial Plan and working with key partners to manage an effective close process

The successful candidate will be entrepreneurial in approach and able to thrive in a fast moving “start-up” environment as well as in a corporate “shared service” organization. The individual will be a strong team player, communicator and business partner, demonstrating Tandigm Health’s commitment to superior customer service, quality, care, and concern teammates and stakeholders.

The individual provides comprehensive professional services in the area of experience studies, and business, financial and return on investment analysis, ensuring the company achieves stretching business objectives.

Essential Functions

  • Responsible for critical risk analyses, identifying, investigating and resolving outliers and partnering with key business leaders to prevent recurrence. These analyses would be across all Medical and Pharmacy costs associated with Tandigm’s population of over 100,000 members.
  • Provide evaluation/due diligence support to the CEO, CFO and Business Development in:
    • Establishing the annual update to the Value-Based agreement between IBC and Tandigm
    • Evaluating new Value-based contract opportunities with Providers
  • Maintain a strong partnership with Tandigm’s Actuarial Shared Service provider to manage enterprise actuarial functions, ensuring clear visibility of emerging trends, risks and mitigation plans.
  • Manage/support annual Planning and monthly Forecasting
  • Manage the preparation and interpretation of actuarial information, studies, and modeling. Present findings and recommendations to management.
  • Actively support the development and creation of new insights by partnering with Informatics.
  • Provide expert guidance to support the creation of systems specifications, contracts, and other actuarial aspects of value-based healthcare arrangements.
  • Ensure Tandigm maintains a high level of credibility by maintaining strong working relationships with customers, stakeholders, and advisors.
  • Monitors and analyzes developments in actuarial techniques, laws, and regulations applicable to company operations and communicates implications and recommendations to impacted areas.
  • Performs additional duties as assigned.

Education

  • Bachelor’s degree from an accredited college or university in actuarial science, mathematics, business, finance, economics, statistics or relevant field; or equivalent combination of relevant experience and/or education.
  • Member in good standing of the American Academy of Actuaries. Professional certification from the American Academy of Actuaries: or Associate or Fellow designation in the Society of Actuaries (SOA) in good standing required. ASA, FSA, MAAA designations preferred.

Experience

Five to seven years of relevant actuarial experience in the health insurance industry, including provider network and medical expense program evaluations and value-based contracting or Accountable Care Organization (ACO) development, is highly preferred

Knowledge, Skills, and Abilities

  • Knowledge of:
    • Specialized commercial actuarial and insurance industry theories, practices, guidelines and rating methodologies.
    • Actuarial and HMO rating concepts, capitation contracts, provider reimbursement mechanisms, product development and pricing, and quantitative analytical methods.
  • Familiarity with insurance plan system/process design.
  • Understanding of healthcare reform
  • Strong analytical skills and evaluation, and problem-solving abilities, including financial analysis, trending and reporting, analytical, and statistical sampling.
  • Ability to meet changing business priorities and think strategically.
  • Critical Behaviors:
    • Strong verbal, written and presentation skills, including the ability to work well with all levels of management in the company
    • Highly resourceful
    • Ability to thrive in an entrepreneurial but highly regulated industry. Ability to deliver in an environment of multiple projects and deadlines
  • IT and Business Intelligence:
    • Significant experience with medical/prescription drug claim databases and database software packages, such as SQL
    • Proficient in Microsoft PowerPoint, Excel, and Word

Physician Requirements in Accordance with ADA

  • Carrying/Lifting:              Occasional / 0-10 lbs
  • Standing:                         Occasional  / Up to 3 hours per day
  • Sitting:                             Constant/Up to 8 hours per day
  • Walking:                          Occasional/Up to 1 hour per day
  • Repetitive Motion:           Keyboard activity, telephone use, writing
  • Visual Acuity:                   Ability to view computer monitor and read newsprint with or without corrective lenses
  • Environmental Exposure: None

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