Actuarial Consultant - PHSO

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Job description

Description

Actuarial Consultant - PHSO | AdventHealth Corporate

Location Address: 101 Southhall Lane, Maitland. FL 32751

Top Reasons to Work at AdventHealth Corporat

• Great benefits
• Day 1 Health Insurance Coverage
• Career growth and advancement potential

Work Hours/Shift:

• Full-Time, Monday - Friday

You Will Be Responsible For:

• Assesses risk of new Medicare, Full Risk, and Value-Based contracts
• Assists with setting targets in the payor contracting process
• Calculates trends and projections for Medicare Advantage, Medicare Innovative Payment Models, Full Risk, and Value-Based contracts
• Develops trend models and health outcomes analyses to evaluate cost improvement, quality improvement, and care management projects and programs
• Develop and improve IBNR models on an ongoing basis
• Builds strong relationships with leadership, customers, and peers. Communicates appropriately and effectively with stakeholders, customers, and supervisors, maintaining awareness of any issues, potential delays, and any situation of concern that may affect the productivity of supported programs, processes, and systems
• Work collaboratively to prioritize work to meet contractual goals
• Perform other duties as assigned to ensure smooth and efficient operations of the organization

Qualifications

What You Will Need:

Education and Experience Required:

• Bachelor's Degree in Actuarial Science, Mathematics, Statistics, Economics, Finance, or related field
• Minimum 5 years of actuarial related experience in a health plan, healthcare consulting, or population health organization

Licensure, Certification or Registration Required:

• ASA (Associate of the Society of Actuaries) Designation

Knowledge and Skills Required:

• Experience with Medicare products, including Medicare Advantage and the Medicare Shared Savings Program
• Experience with Individual Exchange Benefit Plans
• Experience with Risk Adjustment programs
• Knowledge of the financial structure and processes of Value Based Payment, ACO, and Medicare Innovative models (e.g., Direct Contracting)
• Excellent analytical, problem solving, prioritization and operational skills
• Excellent verbal and written communication skills
• High-level interpersonal skills. Able to work collaboratively and tactfully with multi-disciplinary and diverse teams that may include senior executives, employees, and customers
• Effective computer skills, particularly Microsoft Office Outlook, Word, Power Point and Excel
• Work independently to complete assigned tasks

Job Summary:

The Actuarial Consultant is part of a team that will assist the Population Health Services Organization in the transition from traditional risk models to Value-Based Care models and other innovative solutions to the healthcare risk challenges of today. These types of challenges require an Actuarial Consultant who is not only technically strong but also innovative and can adapt quickly to the changes in the industry. The Actuarial Consultant is responsible for assisting leadership in providing strategic and technical services related to risk assessment, projections, and trend analysis. The Actuarial Consultant will assess risk of new and existing contracts and make recommendations as how to mitigate that risk. The Actuarial Consultant is responsible for developing models that will assist with member intervention and be able to evaluate the value of those models and programs. The Actuarial Consultant will be experienced with Medicare products, including Medicare Advantage, the Medicare Shared Savings Program, and have knowledge of Innovative Payments Models (e.g., Direct Contracting.)

This facility is an equal opportunity employer and complies with federal, state and local anti-discrimination laws, regulations and ordinances.