Senior Healthcare Actuarial SME

This is a fully remote position, open to applicants in United States.

📋 Description

• Oversee actuarial assessments of intricate medical and dental healthcare proposals amounting to nearly $1 trillion.

• Examine solicitation criteria, actuarial guidelines, evaluation standards, data requirements, amendments, and Government assumptions to ensure compliance.

• Analyze actuarial models, rate formulation techniques, utilization metrics, unit costs, trend factors, risk modifications, population assumptions, and impacts on the provider network.

• Evaluate the quality, completeness, credibility, and uniformity of claims, encounter, eligibility, membership, provider, and utilization data.

• Investigate actuarial assumptions such as IBNR, seasonal trends, benefit modifications, population diversity, geographic differences, reimbursement rates, network discounts, credibility assessments, and normalization.

• Conduct independent testing of significant calculations, models, sensitivity analyses, and scenarios to ensure mathematical and methodological precision.

• Compare Offeror assumptions and outcomes against historical data, independent evaluations, Government assumptions, market information, and other benchmarks.

• Recognize methodological flaws, unsupported assumptions, data constraints, inconsistencies, uncertainties, and potential financial or performance risks.

• Formulate clarification inquiries and negotiation suggestions accompanied by supporting rationale and potential financial implications.

• Draft sections of the Price Analysis Report, briefings, exhibits, and materials to support negotiations.

• Revise analyses throughout the proposal updates and negotiations while maintaining traceable workpapers, adhering to applicable actuarial standards, and safeguarding sensitive information.

⛳️ Requirements

• Bachelor’s degree in Actuarial Science, Mathematics, Statistics, Economics, Healthcare Analytics, or a related discipline.

• Over 6 years of experience conducting managed-care actuarial analysis for a Federal healthcare program or major payer, including evaluation of proposals, bids, or rate submissions.

• More than 6 years of experience in analyzing healthcare utilization, unit costs, trends, IBNR, risk adjustments, provider reimbursements, and network pricing.

• Proven experience in developing, reviewing, or validating complex healthcare cost projections.

• At least 6 years of experience in drafting actuarial findings that support proposal clarifications and negotiation stances.

• Currently eligible to work in the United States on a full-time basis.

• Capability to secure a Public Trust Security Clearance.

🏝️ Benefits

• Comprehensive medical benefits, which include dental and vision coverage.

• 401(k) contribution plan.

• Paid holidays and personal time off.

• Opportunities for professional development training and certification benefits.

• Health and wellness subsidies.

• Paid time off for community service activities.

• A thorough Total Rewards package.

• Reasonable accommodations may be provided for individuals to perform essential job functions.