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.

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Actuarial & Analytics
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ConnectiCare
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Summary
Perform high level actuarial analyses for both Commercial and Medicare  business, including, but not limited to: medical expense analyses and projections, Individual rating, Small Group rating, Large Group book of business rating, financial forecasts, regulatory rate filings, actuarial modeling, and ad hoc actuarial analyses/advice as needed. Monitor trends and changes in the actuarial field and healthcare industry and communicate findings to management and associates. 


Responsibilities

  • Utilizes complex mathematical models and applies sound actuarial principles to all financial/pricing analysis and to all aspects of decision-making processes. Performs high level financial/actuarial analyses for the ConnectiCare business.
  • Develops actionable recommendations to management relative to actuarial analyses.
  • Provides business planning guidance through the use of data/analysis to promote information-based decision-making throughout the organization in support of growth and profitability goals.
  • Participates in the development of the annual Medicare Bid process. 
  • Proactively identifies, communicates, and leads organizational dialogue related to healthcare cost/trend opportunities and risks throughout the organization.
  • Analyzes historical medical expenses, and projects future medical expenses and required revenues for Commercial and Medicare  product lines. Develops state rate filings, including peer review as necessary.  Works with actuaries at the Department of Insurance to secure timely approval of rate filings.
  • Compiles data and analysis for use at rate filing hearings with the state insurance department.
  • Leads the development of appropriate small and large group Manual rate levels, rating adjustment factors, and price relativities among and between product and benefit options. Develops and maintains pricing tools used by Small and Large Group underwriting teams.
  • Designs and develops sound data-based tools and applications necessary to efficiently measure, monitor, and/or forecast ConnectiCare’s medical cost structure.
  • Leads the assessment of the pricing impact of all relevant senior management policy decisions, including but not limited to changes in products, underwriting policy, provider contracts, etc.
  • Performs monthly analysis identifying opportunities to reduce cost and utilization.
  • Provides actuarial support to monthly financial close process, including review of IBNR.
  • Monitors and evaluates competitor rates, trends, and rating methodologies.
  • Analyzes key product performance measures including, but not limited to, medical cost trends, premium yields, book-of-business loss ratios. 
  • Promotes idea generation in support of organizational healthcare cost reduction strategies.
  • Initiates key analysis to improve overall MLR results.
  • Estimates mandated benefit costs and calculates pricing of non-standard benefits and riders as needed. 
  • Works closely with actuarial teams, outside consultants and management to ensure that projects conform to Actuarial Standards of Practice.
  • Builds strong inter-dependent relationships within the organization as appropriate, including finance, network pricing, product pricing, underwriting, and clinical operations functional areas.
  • Performs other related projects as needed.    

Qualifications

  • A.S.A required. Bachelor’s degree required, preferably in Actuarial Science, Mathematics, Statistics, Finance, or related field, or an equivalent combination of education and experience.
  • At least 5 years of previous experience in actuarial work in health insurance. Includes at least 3 years of managed care rate development, including Medicare Advantage.
  • Excellent quantitative, problem solving, and analytical skills.
  • Strong communication skills, both oral and written.
  • Strong project management skills.
  • Proficient with personal computers. Strong spreadsheet skills required; experience with SQL or similar query and report development software preferred.
     

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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