This full time Associate Actuary/Senior Actuarial Analyst position can work from any of our SSM Healthcare regions/locations (WI, OK, MO, IL). Responsible for the evaluation of potential and/or continuing at risk contracts that SSM and affiliates may engage in. Specifically supporting any direct to employer arrangements that SSM may endeavor to enter into including analytics around the presentation of a value proposition in creating narrow networks, care management activities, and other utilization controls. Additionally, developing methodologies for incentivizing utilization control, sharing risk with partner organizations such as those in a Clinically Integrated organization, employers, or other entities.
Essential Job Duties:
Develop and/or evaluate Direct to Employer or Value Based Care arrangements by CMS and other third party payers that may include gainshare and downside risk for SSM
Form recommendations on adjustments to at risk and narrow network arrangements-possible alternatives.
Develop monthly reporting packages on direct to employer and other value based care arrangements providing material appropriate for the intended audience.
Work with corporate finance, population health, and other teams to create targeted value propositions in regards to value based care and/or direct to employer arrangements-may include provider reimbursement evaluation
Analyze steerage towards plans and/or in network utilization needed for value proposition as well as sensitivity tests.
Be able to develop and present recommendations on premium and/or benefit differentials that may be needed to create a workable arrangement. Drive plan choice and or network utilization.
Develop methodologies and/or sensitivity testing in tail risk in any at risk arrangements where SSM is taking on risk similar to a stoploss arrangement.
Work with TPA's, providers, other carriers to outline data requirement needs, evaluate data provided
Work with vendors such as Milliman, Optum, and consultants as needed to support analytics and models.
Support any filings that may be needed for arrangements
Develop methodologies for evaluating potential opportunities for improvement in outcomes of at risk arrangements.
Evaluate and develop models of risk sharing between SSM or affiliates and employers or insurers.
Be able to assist in preparing and/or presenting to employer groups, internal clients, TPA's, and insurers
Coordinate with large groups, other insurers, vendors, and internal clients as needed.
As needed support other actuarial or other advanced analytic models across the system.
Serve as a team lead, provide training and feedback to departmental staff, including assisting others with the incorporation of actuarial concepts into their projects.
Bachelor Degree in Actuarial Science, Statistics, Mathematics, Economics, or Finance
At least seven years of actuarial related work experience in healthcare field
Strong math and data modeling skills
Associate of the Society of Actuaries
Strong to advanced knowledge of MS-Excel, SAS, and SQL.
Ability to handle multiple tasks simultaneously, meet time sensitive deadlines and organize workload with general supervision
Demonstrated ability to effectively work in cross-functional teams, and explain technical information to non-technical personnel at all levels.
Ability to develop innovative models and methods for new scenarios and products
Ability to help direct and guide healthcare analysts.
Occasional travel may be required to other SSM Regions locations
Excellent verbal and written communication skills
Working knowledge of government programs rules and guidelines
Experience analyzing claim detailed information down to a micro level (providers, diagnosis codes, procedure codes, etc) to support Population Health / Value Based Care analytics.
Experience working in a Medical Economics Department at a Health Plan or Provider organization.
Experience coordinating with vendors and consultants
Experience with communicating and presenting to external audiences
Self-funded familiarity and experience
Familiarity with claim line detail information
Experience in developing new products and offerings.