Senior Financial Actuary

Mercyhealth•Janesville, WI

10d

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 is accurate, complete, and timely for financial reporting, reserving, and business decision-making. The actuary independently performs assigned analyses and contributes to improving actuarial processes, models, controls, and reporting. The role also advises on strengths, weaknesses, and potential risks by line of business. Responsibilities include retrieving and reconciling financial data; preparing and analyzing health insurance claim reserves and other actuarial liabilities; providing actuarial estimates and reports for financial reporting; forecasting financial results and conducting scenario and variance analyses; and supporting risk adjustment and reinsurance work. The role also supports audits, regulatory compliance, privacy and security requirements, and the year-end financial close, including work with the outside actuary on the Statement of Actuarial Opinion. The position is scheduled for 32 hours per week, Monday through Friday, on day shifts. The listed pay range is $135,072.61–$216,116.18. Mercyhealth describes its benefits package as including insurance coverage, paid time off, leave, educational opportunities, reimbursement, well-being programs, discounts, and other employee programs.

Requirements

Bachelor’s degree in Actuarial Science, Mathematics, Statistics, or a related quantitative field.
Minimum 10 years of relevant actuarial experience.
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 clearly communicate complex actuarial and financial concepts 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 and 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, membership, risk adjustment, and other source systems; maintain reconciliation data and documentation.
Validate data and perform reasonableness checks before use in reserving or financial reporting; investigate and resolve significant discrepancies.
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, using appropriate actuarial methodologies and assumptions.
Prepare reserve estimates by line of business and market, as appropriate, and prepare premium deficiency, risk adjustment, reinsurance, and other actuarial liabilities or financial estimates as applicable.
Analyze reserve adequacy, identify emerging claim trends and other factors affecting future results, perform actual-to-expected analyses, and explain changes in reserve estimates.
Maintain the risk adjustment scoring algorithm annually and update MercyCare risk scores monthly to support reserving and risk adjustment analyses.
Advise management about significant changes in reserve estimates and 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 within reporting deadlines.
Work with Finance on quarterly Medicaid financial reporting; assist with MLR calculations and related analyses; prepare financial reporting exhibits and management reports and communicate key drivers of financial results.
Support reporting related to 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 financial results; perform variance analyses and explain significant actual-versus-expected differences.
Support annual budgeting and financial planning; develop financial scenarios and sensitivity analyses; provide actuarial analyses to support management decisions and business planning.
Support financial analysis of ACA risk adjustment, including receivables, payables, estimates, and changes in expected results as applicable.
Direct the Claims Department in prioritizing pended claim processing during Q1 for risk adjustment optimization.
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 the monthly commercial reinsurance notification and filing process and lead the annual reinsurance renewal process, providing data and analyzing quotes.
Protect PHI, PII, confidential member information, and other sensitive information; maintain confidentiality and safeguard company assets and resources.
Use company systems, data, and resources responsibly and complete required privacy, security, compliance, and other company training.
Assist with regulatory filings and supporting actuarial documentation; identify and escalate potential control weaknesses, data integrity issues, or financial risks; support compliance with actuarial standards, insurance regulations, accounting requirements, and company policies.
Perform other duties as assigned.