CareMore is a proud member of the Elevance Health family of brands, offering clinical programs and primary care options for seniors. We are a team of committed clinicians and business leaders passionate about transforming American healthcare delivery.
This is a remote, individual contributor role; however, the person in this position must live within 50 miles of an Elevance Health office location. Work schedule: Monday - Friday, 8:00 am to 5:00 pm EST or CST
The Actuarial Analyst III completes very diverse and complicated projects and performs very complex actuarial studies.
Primary duties may include, but are not limited to:
- Analyzes and implements risk contracts including conducting experience analyses, pricing, filing and settlement work; and prepares management reports supporting new capitation initiatives.
- Assists in training of actuarial trainees, analysts and specialists.
- Coordinates/directs special actuarial projects.
- Collaborates with the data warehouse analysts in establishing business rules and monitoring adherence.
- Provides business expertise regarding the appropriate use of data elements and cooperates with reporting personnel from other areas to establish and maintain these common business rules.
- Translates data trends into strategic recommendations for program development and action plans.
- Tracks and prioritizes projects through coordination and negotiation with internal and external clients to improve the efficiency of information/project plan generation.
- Evaluates and triages potential projects and studies based on the value, cost benefit analysis and the urgency of the request.
- Performs strategic data analysis (data mining) and research as appropriate to support business needs (e.g., disease management, provider profiling, etc.).
- Develops detailed understanding of relevant business processes, goals and strategy in order to provide analysis and interpretation.
- Develops and communicates action plans to address areas for improvement identified through data analysis and business expertise.
- Assists in planning initiatives to address areas for improvement.
- Collaborates with business user to define media, frequency and audience for distribution of information.
- Mentors (formally and informally) less experienced associates and identifies training needs and initiates education to address skill and knowledge gaps.
- Requires a BA/BS and to have passed a minimum of four Society of Actuaries (SOA) actuarial exams and a minimum of 3 years related experience; or any combination of education and experience, which would provide an equivalent background.
Preferred Skills, Capabilities, and Experiences:
- Excellent knowledge and understanding of data warehouse data structures and data flows is strongly preferred.
- Excellent oral and written communication, analytical and planning skills and knowledge of standard Business Information tools and programming/query languages preferred.
- Experience in managed care and data analysis is preferred.
- Practical business experience is preferred.
- Background in Medicare or other public health insurance programs with understanding of risk adjustment programs
- Actively working towards ASA/ FSA.
- SAS, SQL, and other programming language experience preferred.
- 2-4 years of experience in an actuarial department, Medicare Advantage risk adjustment experience preferred.
- Proficiency with Microsoft office tools with emphasis on Excel preferred.
Please be advised that Elevance Health only accepts resumes from agencies that have a signed agreement with Elevance Health. Accordingly, Elevance Health is not obligated to pay referral fees to any agency that is not a party to an agreement with Elevance Health. Thus, any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.
Be part of an Extraordinary Team
Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. A Fortune 20 company with a longstanding history in the healthcare industry, we are looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. You will thrive in a complex and collaborative environment where you take action and ownership to solve problems and lead change. Do you want to be part of a larger purpose and an evolving, high-performance culture that empowers you to make an impact?
We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.
Elevance Health operates in a Hybrid Workforce Strategy, providing various levels of flexibility while also ensuring that associates have opportunities to connect in-person. Unless in a designated virtual-eligible role and specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process. Candidates must reside within 50 miles or 1-hour commute each way of a relevant Elevance Health location.
The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19. If you are not vaccinated, your offer will be rescinded unless you provide – and Elevance Health approves – a valid religious or medical explanation as to why you are not able to get vaccinated that Elevance Health is able to reasonably accommodate. Elevance Health will also follow all relevant federal, state and local laws.
Elevance Health has been named as a Fortune Great Place To Work in 2022, has been ranked for five years running as one of the 2023 World’s Most Admired Companies by Fortune magazine, and is a growing Top 20 Fortune 500 Company. To learn more about our company and apply, please visit us at careers.ElevanceHealth.com. Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact email@example.com for assistance.