Actuary - Medical Cost Initiatives (Remote) at UPMC

Pittsburgh, Pennsylvania, United States -

Full Time

Start Date

Immediate

Expiry Date

10 Sep, 26

Salary

0.0

Posted On

12 Jun, 26

Experience

5 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Actuarial Modeling, Financial Projections, Medical Cost Analysis, SQL, SAS, Data Visualization, Statistical Analysis, Health Economics, Trend Analysis, Population Health, Utilization Management, Care Management, Disease Management, Cross-functional Leadership, Strategic Planning, Relational Databases

Industry

Hospitals and Health Care

Description

Purpose: Shape the world of health care by joining UPMC! As a leader in the industry, we are committed to enhancing the lives of all who are a part of our community. Without our employees, we would not be able to innovate health care for our patients and health plan members. From hospitals to our corporate office, all UPMC employees impact our mission of creating life changing medicine. To continue our tradition of excellence, we are in search of a full-time Actuary to join this community as well. UPMC Health Plan is seeking an Actuary in its Department of Health Economics! This credentialed healthcare actuary would drive high-visibility impactful analysis and would be responsible for developing and driving medical cost improvement strategies. This includes evaluating program and initiative outcomes, interpreting cost and trend driver analysis to generate new initiative ideas and present findings to leadership. The Actuary will require a diverse set of skills and experience, including data and analytics expertise, broad-based business and health economics acumen, a strategic mindset, and an ability to influence and leverage cross-functional teams in a non-traditional actuarial environment. This position may also direct or supervise less experienced actuarial analysts in the performance of duties. As an Actuary at UPMC, you will be given support for professional designations through our comprehensive student program and continuing education opportunities. Responsibilities: Lead the development of detailed actuarial and financial models to communicate near and long-term projections of financial performance of new and ongoing initiatives and clinical programs to facilitate corporate decision-making and the development of strategies and goals. Analyze impacts of healthcare affordability initiatives on medical cost and utilization trends. Apply analytical and statistical software tools to summarize large healthcare data to glean findings and actionable insights and deliver results to leadership. Incorporate healthcare claims cost and utilization trends into the development of projections used to define savings methodologies for affordability initiatives and programs. Develop and gain support for data-based recommendations with team members from product, clinical, network, and strategy functions. Guide the development of well-documented standard actuarial reports and projects. Present results of analyses and recommendations to management and senior leaders. Apply an understanding of complex actuarial concepts, methods, and applications in a variety of situations. Creatively leverage a wide range of datasets to inform key analyses. Provide direction and supervision to less experienced staff in the performance of duties. May directly manage 1-2 analyst. Build strong relationships within cross-functional workgroups including Clinical, Pharmacy, Network, Actuarial, Analytics, and Finance teams across the enterprise. Ensure that departmental work products meet the highest standards of quality. Provide analytical support for ad hoc data analyses. Bachelor's degree in mathematics, statistics, actuarial science, economics or related field. ASA of FSA certification 5+ years of experience in actuarial work in a health insurance, managed care or related consulting business; or equivalent training, education and/or experience. Experience in any of the following is a strong preference: evaluation of medical cost and utilization savings initiatives; statistical techniques for the evaluation of clinical programs; trend analysis; population health; utilization management (UM) / care management (CM) / disease management (DM) analysis Experience with commercial and government health programs is preferred. In-depth understanding of health insurance market dynamics. Excellent problem-solving and analytical skills. Excellent oral and written communication skills. Adaptability and ability to prioritize effectively. Strong PC skills. Data retrieval skills and relational database experience are required, including SQL and/or SAS. Data visualization experience is preferred. Licensure, Certifications, and Clearances: A.S.A. or F.S.A. certification by Society of Actuaries Membership in the American Academy of Actuaries UPMC is an Equal Opportunity Employer/Disability/Veteran

Responsibilities

Lead the development of actuarial and financial models to project the performance of medical cost improvement strategies and clinical programs. Analyze healthcare affordability initiatives and present actionable insights to senior leadership to drive corporate decision-making.