Senior Healthcare Actuarial Consultant (Work From Home)

at  NeueHealth

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We are transforming healthcare to be value-driven, creating a seamless, consumer-centric care experience that maximizes value for all.
We believe that all health consumers are entitled to high quality, coordinated healthcare. We uniquely align the interests of health consumers, providers, and payors to make high-quality healthcare accessible and affordable to all populations across the ACA Marketplace, Medicare, and Medicaid.
Preferred locations for applicants - MN, TX, FL, NY
The Senior Actuarial Consultant will lead actuarial workflows in support of ACO REACH & MSSP performance evaluation and forecasting. In addition, this role leads value-based contracting (VBC) workflows to include evaluation and forecasting of full and partial risk arrangements between NeueHealth affiliated providers and payors from multiple LOBs (Commercial, Medicare Advantage, Medicaid, etc.). Additional cross-functional support role working with Line of Business, Analytics, Finance, Marketing and other areas of the company that may need data summarization, modeling framework or research help.

EDUCATION, TRAINING, AND PROFESSIONAL EXPERIENCE

• Bachelor’s degree required in Math, Statistics, Economics, Actuarial Science, or a related field
• 4+ years of actuarial experience with 5+ years working within healthcare
• 2+ years working with a CMMI ACO Model (of any kind) is strongly preferred
• 2+ years performing medical IBNR / Reserving calculations is strongly preferred
• 2+ years working with individual/small group ACA rate filings or Medicare Advantage bids is preferred
• Working knowledge of the CMMI Direct Contracting or Accountable Care Organization (ACO) program(s)
• Working knowledge of industry value-based contracts between payers and providers (risk sharing arrangements)
• Experience leading projects and ownership of deliverables

• Support the Government Programs & Provider Risk Actuarial Models team’s development of actuarial models to be used for medical expense and trend analysis and forecasting, provider risk contract evaluation, and ACO REACH / MSSP performance evaluation.
• Lead quarterly medical expense analysis, IBNR / Reserving (monthly), and forecasting process, with assistance from actuarial analyst staff.
• Document and present summary review memos in support of the quarterly medical expense analysis and forecasting process in preparation for, and as follow up to, collaboration with various owned clinics and NeueHealth SMEs and leaders.
• Lead the evaluation of financial implications of provider participation in networks for ACO REACH / MSSP opportunities.
• Lead provider risk contract evaluations and ACO REACH / MSSP performance evaluations, interfacing with internal NeueHealth team and external consulting actuaries.
• Collaborate with Finance team in the development of forecasting models, projections and relevant information to inform C-Level business decisions.
• Lead the development of contract analysis assumptions to inform contract evaluation decisions and plan benefit development and provide guidance to NeueHealth and the owned clinics teams.
• Perform ad-hoc data analysis using Excel, SAS, SQL (Databricks).
• Other duties and responsibilities as assigned.