Company Statement
EmblemHealth is one of the nation’s largest not for profit health insurers, serving members across New York’s diverse communities with a full range of commercial and government-sponsored health plans for employers, individuals, and families. With a commitment to value-based care, EmblemHealth partners with top hospitals and doctors, including its own AdvantageCare Physicians, to deliver quality, affordable, convenient care. At over a dozen EmblemHealth Neighborhood Care locations, members and non-members alike have access to community-based health and wellness guidance and resources. For more information, visit emblemhealth.com.
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Senior Actuarial Analyst (Pharmacy)
- 💼
- EmblemHealth
- 📅
- 1 day ago Post Date
REMOTE
Summary:
- Identify opportunities to reduce medical expenses and collaborate with other areas to implement and monitor performance.
- Participate in product development, pricing, filing, and rating implementation of new products and strategies.
- Develop studies, analyses, and presentation materials needed to appropriately inform decision makers.
- Answer questions of less experienced staff.
Responsibilities:
- Analyze and understand hospital, professional, and drug claim/utilization trends, membership/demographics, and financial variance to budget, and performs various other ad-hoc analyses.
- Maintain appropriate controls around models and other work products.
- Ensure quality and on time completion of deliverables.
- Provide support for coordination of quarterly close activities.
- Partner with key stakeholders to develop and finalize valuation methodologies.
- Prepare and analyze results and forecasts.
- Perform monitoring processes for trends and risk valuation calculations.
- Develop efficient and transparent queries to obtain data that is appropriate to the purpose with minimal assistance and oversight.
- Make appropriate recommendations to management across teams within the actuarial department.
- Proactively ensure the internal and external consistency of all work.
- Perform reasonability checks dependent on industry knowledge and experience.
- Develop and implement analyses for special projects.
- Provide technical and analytical support for both the Actuarial department and internal partners.
- Proactively take on additional work as needed by the team.
- Perform duties and assignments as directed or required.
Qualifications:
Education, Training, Licenses, Certifications
- Bachelor’s degree in Actuarial Science, Mathematics, other physical science, or related finance/business degree required
- Associate of the Society of Actuaries required
Relevant Work Experience, Knowledge, Skills, and Abilities
- 4 - 6+ years of relevant, professional work experience and/or education required
- 1 - 2+ years health insurance actuarial experience, preferably in the managed care industry required
- Must make sufficient progress toward obtaining actuarial credentials, defined as sitting for a minimum of one exam per year, scoring above a zero, and obtaining at least a combined score of 5 over two consecutive sittings
- When unable to meet the progress outlined in the bullet above, the role will be transitioned to a non-Actuarial job title and job description
- Comprehensive understanding of actuarial principles and methodologies and strong mathematical and analytical skills required
- Excellent communication skills (verbal, written, presentation) required
Strong working knowledge of MS Office including Outlook, Word, Excel, PowerPoint, etc. required
Working knowledge of SQL, R, Python or similar required
Capable with Excel, data extraction, simulations, automation required
- Knowledge of reimbursement methodologies required
- Capable with Excel, data extraction, simulations, automation.
- Knowledge of reimbursement methodologies.
Security Disclosure
If you receive a job offer from EmblemHealth, the email will be from “HRTalentAcquisition” with the subject: “Offer of Employment for (job title) – Please respond online.” We will never ask you to join a Google Hangout, buy your own equipment, or pay to apply. We also do not use third-party email services like Yahoo or Gmail.
Pay Disclosure
At EmblemHealth, we prioritize transparency in our compensation practices. We provide a good faith estimate of the salary range for potential hires, which is based on key factors such as role responsibilities, candidate experience, education and training, internal equity, and market conditions. Please be aware that this estimate doesn’t account for geographic differences related to your work location. Typically, new hires may not start at the top of this range, as compensation is tailored to each individual's circumstances. For union positions, salaries will be determined according to the collective bargaining agreement. Join us at EmblemHealth, where your contributions are valued and supported by fair compensation.
EEOC Statement
We value the diverse backgrounds, perspectives, and experiences of our workforce. As an equal opportunity employer, we consider all qualified applicants for employment regardless of race, color, religion, sex, sexual orientation, age, creed, citizenship status, gender identity, pregnancy, marital status, national origin, disability, veteran status, or any other protected characteristic protected by law.
Sponsorship Statement
At EmblemHealth, we are committed to building a diverse and talented workforce. However, we are unable to consider applicants who require, or are likely to require, either before or after hire, visa sponsorship for work authorization in the United States, including but not limited to H-1B, F-1 (STEM OPT), TN, or any other non-immigrant status. Some extremely rare exceptions may apply based on critical business needs.