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Overview

As a Risk Revenue Analyst-Senior the incumbent will provide a full scope of actuarial and statistical analyses, specifically designed to support pricing and bidding for Medicare Advantage plans. Such projects will support both internal and external customers. The position will require working collaboration with other team members and business units throughout the organization. Also, this position will work to develop efficient processes and apply actuarial techniques and statistical analysis to several functions, including insurance premium and pricing development, claim trend analysis, experience studies, medical economics, profitability analysis, wellness studies, or predictive modeling. This role will require strong analytical skills.

Qualifications

• Bachelor’s degree required in Mathematics, Statistics, Actuarial Sciences, or related field. Master’s degree preferred. ASA designation preferred.
• Five (5) years of Actuarial or related experience required.
• Strong understanding of Actuarial concepts, functions, and processes and how they relate to the enterprise, including how they impact operations and financials.
• Expert understanding of health care concepts and products, and detailed understanding of the health care environment including government regulations and competitive landscape.
• Proficient PC skills in a Windows environment. Advanced knowledge of Excel, SAS and other analytic or query tools required. Programming and coding experience required.
• Proven ability to handle data sources, filter and assess data quality, and recognize data patterns required. Strong problem-solving skills required. Must be able to develop information derived from multiple and varied inputs and communicate and interpret that information.
• Minimal supervision required on projects. Develops and supports complex projects.
• Excellent oral and written communication skills. Demonstrated self-motivation and initiative, as well as an ability to perform under pressure. Strong interpersonal skills. Strong organizational skills and ability to prioritize, multitask, and work in fast paced environment.
• Proven examples of displaying the IH values: Passionate, Caring, Respectful, Trustworthy, Collaborative and Accountable.

Essential Accountabilities

• Support budget development process including forecasting and actual to budget comparison. Communicate with external departments to support budget preparation. Assess and validate budgetary assumptions.
• Support development and forecasting of accruals for Finance and Accounting for various financial statement items.
• Perform actuarial analysis and modeling including but not limited to pricing and forecasting.
• Develop key inputs and assumptions, conduct sensitivity analyses and scenario testing to assess impacts on pricing outcomes.
• Establish and implement claims review processes to support risk adjustment. Analyze data and provide strategic insights to enhance pricing and financial performance. 
• Ensure compliance with CMS regulations and risk adjustment methodologies.
• Develop and execute pricing strategies, incorporating market trends and competitive analysis.
• Work with product, market, executive, and other cross-functional teams to align risk adjustment decisions with organizational goals.
• Analyze healthcare claims data, enrollment data, and other relevant information to identify trends and patterns.
• Collaborate with data analysts and actuaries to ensure data accuracy in the pricing process.
• Generate regular reports for senior management, highlighting key performance indicators and financial results.
• Propose and assist in the development of process improvements and automation within the department.
• Manage complex projects with complete and thorough understanding of entire process. Responsible for development, support, and improvement of departmental projects with minimal supervision.
• Understand multiple sources of data; identify and utilize most relevant source to complete task. Ensure overall data integrity. Draw together facts and input from a variety of sources; make recommendations to management.
• Provide support to assist management in meeting corporate goals and strategic decision making.
• Initiate and lead the development of actuarial studies, analyses, and presentation materials needed to appropriately inform internal or external decision makers.
• Stay informed of changes in risk adjustment methodologies and their imp