Actuary Jobs

About The Position

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.

Benefits

• Medical, dental, and vision insurance.
• Life and disability insurance.
• FSA/HSA options.
• Generous, accruing paid time off.
• Paid parental and caregiver leave.
• Career advancement and educational opportunities.
• Tuition and certification reimbursement.
• Well-being programs.
• Employee discounts.
• On-demand pay.
• Financial education.
• Annual recognition and awards events.
• Partner appreciation days.
• Family entertainment and attractions discounts.
• Community service and improvement opportunities.