Candidates hired for remote positions must reside in Oregon, Washington, Utah, Idaho, Arizona, Nevada, Texas, Montana, or Wisconsin.

Job Summary

This position is responsible for performing a wide variety of financial and actuarial analyses impacting strategic decision making and the company's financial sustainability efforts. Areas of analysis include cost and utilization trend analysis, return on investment evaluations, Medicare bid development, rate setting optimization, forecasting support, benchmarking, risk adjustment optimization, provider payment evaluation and review of actuarial estimates such as IBNR and PDR.

Essential Responsibilities

Financial and Actuarial Analyses

• Drill down into cost and utilization trends to identify key drivers.
• Develop profitability analytics to support evaluation by provider group, contract, and other valued indicators.
• Design, develop, and implement evaluation tools in measuring the effectiveness of programs and payment models.
• Develop cost savings calculators for use in goal setting, budgeting, and forecasting.
• Provide rate setting support through data analysis, policy review and strategy development.
• Identify any actuarial unsound adjustments to the rates.
• Provide medical cost and utilization trend recommendations for forecasting purposes.
• Gather and develop benchmarks for purposes of assessing our performance and the potential for improvement.
• Monitor risk adjustment applied to capitation revenue and ensure population risk is appropriately represented in encounter data.
• Evaluate provider payment models, including risk share arrangements, to ensure they achieve the desired outcome.
• Prepare regular risk share reporting for sharing with providers and supporting accounting estimates.
• Drive strategic use of data to support business efficiencies and competitive decision-making.
• Review and provide guidance on actuarial estimates of IBNR, PDR and other actuarially determined assets and liabilities.

Financial Analytical Capacity and Capability

• Develop and execute methodologies for new projects.
• Create documentation for new models and projects.
• Summarize analyses into actionable recommendations.
• Work with Information Systems to ensure access to a data source with high data integrity.
• Provide training and support to other Finance users around the data, software, and analytic approaches.

Administration

• Participate in 1:1, team, and department meetings; Attend All Staff meetings.
• Recommend and assist implementation of plans, policies, and procedures; participate in Actuarial Services team goal setting.
• Mentor assigned actuarial staff; assist in training and provide performance feedback to manager.

Organizational Responsibilities

• Perform work in alignment with the organization's mission, vision and values.
• Support the organization's commitment to equity, diversity and inclusion by fostering a culture of open mindedness, cultural awareness, compassion and respect for all individuals.
• Strive to meet annual business goals in support of the organization's strategic goals.
• Adhere to the organization's policies, procedures and other relevant compliance needs.
• Perform other duties as needed.

Experience and/or Education

Required

• Bachelor's Degree in Finance, Mathematics, Economics, or related field
• Associate of the Society of Actuaries
• Minimum 4 years' experience in an actuarial role
• Work experience in health insurance

Preferred

• Work experience in Medicaid or Medicare

Knowledge, Skills and Abilities Required

Knowledge

• Working knowledge of other MS tools, including MS Office products, MS Access
• Strong understanding of data systems and sources and how it impacts the data available
• Knowledge of medical claims, billing practices and health insurance requirements

Skills and Abilities

• Strong data management skills
• Proficiency in SAS, SQL, or similar database querying tools
• Proficiency in MS Excel
• Highly effective communication skills, including listening, verbal, and written
• Willingness to acquire new skills
• Strong attention to detail and accuracy
• Strong ability in articulating and presenting information across multiple areas of the organization
• Ability to effectively lead and participate on a variety of large projects, including complex initiatives across departments
• Ability to identify, implement, and lead process improvements
• Ability to communicate and present to external parties (e.g., auditors, actuaries, regulatory agencies) and stakeholders (e.g., Finance committees, Board of Directors, etc.)
• Ability to produce high quality output
• Ability to effectively review others' work
• Ability to identify problem, inconsistencies, unexpected results, relevant information and uncertainties
• Ability to interpret and analyze information and implement conclusions/solutions
• Ability to assist team members in developing conclusions and solutions
• Ability to effectively prioritize own work
• Ability to complete tasks on time
• Ability to effectively collaborate with coworkers, leaders, executives and stakeholders
• Ability to learn from feedback and embrace change
• Possess a high degree of initiative, motivation, and professionalism
• Ability to maintain a positive attitude

• Ability to work effectively with diverse individuals and groups

• Ability to learn, focus, understand, and evaluate information and determine appropriate actions
• Ability to accept direction and feedback, as well as tolerate and manage stress
• Ability to see, read, and perform repetitive finger and wrist movement for at least 6 hours/day
• Ability to hear and speak clearly for at least 3-6 hours/day

Working Conditions

Work Environment(s): Indoor/Office Community Facilities/Security Outdoor Exposure

Member/Patient Facing: No Telephonic In Person

H Hazards: May include, but not limited to, physical and ergonomic hazards. (Indoor/Office)

Travel: May include occasional required or optional travel outside of the workplace; the employee's personal vehicle, local transit or other means of transportation may be used.

# Li-Remote #MULTI

Candidates of color are strongly encouraged to apply. CareOregon is committed to building a linguistically and culturally diverse and inclusive work environment.

Veterans are strongly encouraged to apply.

We are an equal opportunity employer. CareOregon considers all candidates regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, genetic information, disability, or veteran status.

Visa sponsorship is not available at this time.