Senior Financial Actuary

Mercyhealth Wisconsin and Illinois•Janesville, WI

11d•$135,073 - $216,116

About The Position

The Senior Financial Actuary performs actuarial analyses related to health insurance financial reporting, claim and premium reserving, financial data reconciliation, and forecasting. The role works closely with Actuarial, Finance, Claims, Underwriting, IT/Reporting, and other business areas to ensure actuarial information used for financial reporting, reserving, and business decisions is accurate, complete, and timely. The actuary independently performs assigned analyses and contributes to improving actuarial processes, models, controls, and reporting, while advising on line-of-business strengths and weaknesses and associated risks. The position covers retrieval and reconciliation of financial data; preparation and analysis of health insurance claim reserves and other actuarial liabilities; delivery of actuarial estimates and reporting to Finance; forecasting, budgeting, variance, scenario, and sensitivity analyses; and analysis of risk adjustment, reinsurance, and stop-loss arrangements. It also supports audits, regulatory filings, actuarial documentation, compliance, and protection of confidential information. The schedule is 32 hours per week, Monday through Friday on day shifts.

Requirements

Bachelor’s degree in Actuarial Science, Mathematics, Statistics, or a related quantitative field.
Minimum 10 years of relevant actuarial experience, preferably in health insurance.
Experience working with medical and drug claims, premiums, membership, and related financial data.
Demonstrated experience performing actuarial or financial analyses and reconciling data from multiple sources.
Fellowship in the Society of Actuaries.
Strong analytical, problem-solving, and critical-thinking skills.
Strong attention to detail and ability to identify data, calculation, and financial reporting discrepancies.
Advanced proficiency with Microsoft Excel and other analytical tools.
Ability to manage multiple priorities and meet recurring monthly, quarterly, and annual reporting deadlines.
Ability to communicate complex actuarial and financial concepts clearly to technical and non-technical audiences.
Acquaintance with Microsoft Access tables and queries.
Strong written and verbal communication skills; ability to follow instructions and procedures accurately.
Ability to work independently and as part of a team.
Commitment to confidentiality and ethical standards; adaptability to changing priorities and environments; customer service orientation and cultural sensitivity.

Nice To Haves

Experience with health insurance financial reserving.
Knowledge of statutory or GAAP financial reporting.
Experience with ACA, Medicare Advantage, Medicaid, or other health insurance programs.
Experience with risk adjustment, MLR, reinsurance, and stop-loss.
Experience with SQL, Python, R, Power BI, Power Query, Visual Basic, Excel pivot tables, or other analytical/data tools.
Background supporting actuarial and financial audits.

Responsibilities

Extract information from the data warehouse and other sources efficiently.
Reconcile actuarial data and calculations to the general ledger, financial statements, claims, premium and membership systems, risk adjustment data, and other source systems; maintain reconciliation data and documentation.
Validate data and perform reasonableness checks before using it for reserving or financial reporting; investigate and resolve significant differences.
Help improve data flows, reconciliation processes, and reporting automation.
Support internal and external financial and actuarial audits and periodic reconciliation of MercyCare Planalytics reports.
Prepare and analyze monthly, quarterly, and annual health insurance claim reserves, including IBNR and other unpaid claim liabilities, for applicable lines of business and markets.
Prepare premium deficiency, risk adjustment, reinsurance, and other applicable actuarial liabilities or financial estimates.
Analyze reserve adequacy, identify emerging claim trends and other factors affecting future results, and perform actual-to-expected analyses explaining reserve changes.
Maintain the risk adjustment scoring algorithm annually and update MercyCare risk scores monthly for reserving and risk adjustment analyses.
Advise management on significant reserve estimate changes and the financial implications of emerging trends.
Document reserving methodologies, assumptions, calculations, and conclusions.
Provide claim reserve, premium, membership, risk adjustment, and other actuarial estimates to Finance by reporting deadlines.
Work with Finance on quarterly Medicaid financial reporting; assist with MLR calculations and related analyses as applicable.
Prepare financial reporting exhibits and management reports, communicate key financial drivers, and support reporting for premiums, claims, medical and administrative expenses, risk adjustment, reinsurance, and other health insurance financial items.
Lead the actuarial portion of the year-end financial close and work with the outside actuary on the Statement of Actuarial Opinion.
Develop forecasts of claims, premiums, membership, medical expenses, and other health insurance financial results; analyze variances and support budgeting and financial planning.
Develop financial scenarios and sensitivity analyses and provide actuarial analysis to support management decisions and business planning.
Support analysis of ACA risk adjustment receivables, payables, estimates, and changes in expected results, as applicable.
Direct the Claims Department in prioritizing pended claim processing during Q1 to optimize risk adjustment.
Analyze stop-loss, reinsurance, and other risk-transfer arrangements, including recoveries, attachment points, exclusions, and contractual provisions.
Develop monthly relevant stop-loss reserves for MercyCare stop loss; prepare monthly commercial reinsurance notifications and filings.
Lead the annual reinsurance renewal process, providing data and analyzing quotes.
Protect PHI, PII, confidential member information, and other sensitive information in accordance with HIPAA and applicable privacy and security requirements.
Maintain confidentiality of proprietary actuarial, financial, business, member, provider, and employee information; safeguard company assets and use resources responsibly under company policies.
Complete required privacy, security, compliance, and other company training.
Assist with assigned regulatory filings and supporting actuarial documentation; identify and escalate potential control weaknesses, data integrity issues, or financial risks.
Support compliance with applicable actuarial standards, insurance regulations, accounting requirements, and company policies.
Perform other duties as assigned.