This position will perform actuarial analyses for Commercial and Medicare business including, but not limited to: medical expense analyses and projections, determining rates and preparing supporting documentation for rate filings with DOI and HHS/CMS, pharmacy analytics and projections, building and maintaining rate models, analyzing data in support of monthly reserve process, and ad hoc actuarial analyses.
Provide data and support for the development of rate filings for submission to the Department of Insurance. Includes support documentation.
Provide data and support for the development of Medicare Advantage bids for submission to CMS. Includes support documentation.
Closely monitors and assesses competitors’ rates, trends and rating methodologies.
Supports various initiatives as needed by actuarial modeling.
Develops/enhances ad hoc reports to assist in actuarial analyses of emerging results.
Creates and maintains large databases of information utilizing a unique skill set of spreadsheet and relational database abilities.
Conducts cross-functional analysis of health care data to identify trends and risks.
Develop data and reports in support of reinsurance, risk adjustment and risk corridors, ensuring accurate impacts in pricing and coordination with MLR rebate determination.
Drill into medical expense problem areas, and provide results to Medical Management and Network Operations in order to determine, implement and monitor solutions.
Develops/enhances ad hoc reports to assist in financial analysis of operating results and support for actuarial analyses key to understanding financial position.
Assess the financial or pricing impact of variations in benefits and provider contracts.
Estimate mandated benefit cost and calculate pricing of non-standard benefits and requested riders
Tracks trends and reports pertinent financial and utilization information.
Perform other related projects and duties as assigned.
Technical Knowledge and Experience:
Bachelor's Degree required, preferably in Actuarial Science/Mathematics/Finance/Healthcare Management or a related field or an equivalent combination of education and experience.
At least 2 years of previous experience in actuarial analysis desired.
Excellent quantitative, problem solving and analytical skills.
Strong communication skills.
Technical skills with database concepts, data analysis development, data warehousing and decision support tools.
Knowledge of MS-Office products, particularly MS-Access and Excel are required. Familiarity with SAS desired.
ConnectiCare is an equal opportunity employer. M/F/D/V
Website : http://www.connecticare.com
ConnectiCare is a leading health plan in the state of Connecticut. ConnectiCare’s mission is to make it easy for members to get the care they need. A local company for over 35 years, ConnectiCare has a full range of products and services for businesses, municipalities, individuals and those who are Medicare-eligible. A subsidiary of EmblemHealth, ConnectiCare leads the individual and small group markets in the state, and is ranked among the top commercial health plans in the nation, according to the National Committee for Quality Assurance.