Staff Actuary, Health Plan

Sanford Health•Sioux Falls, SD

13d•$50 - $82

About The Position

Sanford Health is one of the largest and fastest-growing not-for-profit health systems in the United States. We’re proud to offer many development and advancement opportunities to our nearly 50,000 members of the Sanford Family who are dedicated to the work of health and healing across our broad footprint. The Staff Actuary will be required to provide experienced data work flow programming and data-mining skills. Work closely with a multitude of departments, to rapidly understand and navigate new situations, and create solutions, on-the-go analysis and data development for a broad range of financial and actuarial functions. This includes: product pricing and rate reviews, financial planning and forecasting, trend analysis, product development, provider reimbursement analysis, fee schedule development, provider risk analysis, and medical cost containment analysis.

Requirements

Bachelor’s degree in Mathematical Statistics, Mathematics, Actuarial Science, Public Policy Analysis, Mathematical Economics, or Finance required.
Experience in data and analytic skills using SQL, SAS or python coding required
Requires Associate in the Society of Actuaries (ASA).

Nice To Haves

Health insurance experience preferred.

Responsibilities

Perform analytic project work assigned by manager with minimal supervision.
Deliver accurate claims/encounter data analysis.
Provide strong mathematical modeling techniques and statistical concepts to determine probabilities and assess risks.
Develop analytic project plan to meet defined objectives.
Facilitate planning and review sessions.
Collaborate with leader(s) in defining project objectives, and design components of larger projects.
May manage one or more large projects.
Use data systems and query tools to complete work projects, developing new code and tools to meet objectives.
Design and build technical processes to address business issues.
Develop criteria to validate results in light of prior expectations.
Investigate unusual results and offers explanations.
Examine and interpret results in the context of the specific business questions being addressed.
Identify new questions and/or unforeseen data complexities arising from results and takes steps to address them.
Integrate information from multiple sources to interpret results in larger business context.
Perform and support trend analysis.
Perform risk adjustment analytical studies that involve manipulations of large amounts of data.
Identify patterns and trends in diagnostic coding practice in conjunction with risk score measurement.
Conduct gap analysis and data collection and validation.
Stay abreast of government regulations as related to the 3R's.
Conduct complex actuarial analyses to assess risk scores.
Create data-driven solutions for capturing risk and improving quality of care for our members.
Perform vendor return on investment analyses to determine ongoing benefit and decision support.
Develop and execute work plans that may involve collaboration with more than one team.
Identify systems and operational problems, and recommend solutions and changes to streamline procedures for more effective reporting.
Perform root cause analysis.
Analyze enrollment and claims data for patterns and trends to identify opportunities to improve documentation and coding.
Conduct Monthly P&L financial reconciliations and frequent liaisons with the Finance team.
Present reports, explaining their implications to managers and directors, and advising on risk ranges.
Communicate with internal clients and carrying out relationships with financial directors and stakeholders.
Conduct Ad-hoc modeling and projects.
Conduct other responsibilities as assigned.