Company Statement

For the last 80 years, EmblemHealth has been taking care of New York’s heart and soul, its people. Today, health care is more complex than ever. That’s why we’re at the forefront of change. We work alongside our customers to offer access to high-quality, affordable care, help navigate the health care experience, and make good health achievable; because everyone deserves to be taken care of. We deliver on our mission every day by living our values with our colleagues, members, clients and partners. It begins with caring and respecting all those we work with. We believe a culture of diversity and inclusion is vital to serve our unique and diverse customers. We seek for continues improvement and innovation and believe being agile and nimble is our advantage. We bring a strong sense of partnership to every relationship – internally and externally. The EmblemHealth family of companies offers competitive health, welfare, and retirement benefits as well as incentive pay plans and more.

Senior Actuarial Analyst - Provider Network & Clinical

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Manager & Professional
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EmblemHealth
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Provides actuarial services in support of the Provider Network Management and Clinical areas. With specific responsibilities of providing data, analytics and reporting in support of provider contracting and value-based reimbursement arrangements, providing data and analytics in support of vendor management and relationships, analyzing trends and interpreting results for matrix partners, supporting contract negotiations and interpreting results/impacts using data, identifying root causes and opportunities for medical and pharmacy cost savings.

 

Responsibilities:

  • Support ongoing financial analysis and reporting on various provider contracts and Value Based reimbursement arrangements, e.g. ACO Shared Risk/Shared Savings arrangements
  • Provide data and analysis in support of third-party delegate management, from the RFP phase through post-implementation performance tracking and financial oversight (e.g. with ancillary risk vendors, global risk entities)
  • Provide data and analytics in evaluating / validating total medical and pharmacy cost savings in support of the Health Care Cost Containment Initiatives (HCCI) process. 
  • Analyze, understand, and explain trend variances.  Identify opportunities/initiatives to reduce medical costs.
  • Provide other actuarial analysis as required to Provider Contracting area.
  • Regular attendance is an essential function of the job.  Performs other duties as assigned or required.

Qualifications:

  • Bachelor’s degree in Economics, Mathematics, or similar major required; advanced degrees a plus
  • Minimum of 2 Society of Actuaries exams passed
  • Proficient in Excel required; SAS preferred
  • 1-2 years health insurance actuarial experience, preferably in the managed health care industry required
  • Intermediate understanding of actuarial principles and methodologies along with good mathematical and analytical skills required
  • Highly proficient in the application of spreadsheet and database management software required
  • Familiar with medical trend analyses required
  • Excellent communicator required
  • Demonstrated ability to learn and adapt required
  • Demonstrated team player required

EEOC Statement

We are committed to leveraging the diverse backgrounds, perspectives and experiences of our workforce to create opportunities for our people and our business. We are an equal opportunity/affirmative action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, protected veteran status or any other characteristic protected by law.

Sponsorship Statement

Depending on factors such as business unit requirements, the nature of the position, cost and applicable laws and regulations, EmblemHealth may provide work visa sponsorship for certain positions.

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