Job Description
Posted Tuesday, April 9, 2024 at 4:00 AM
Paradigm is an accountable specialty care management organization focused on improving the lives of people with complex injuries and diagnoses. The company has been a pioneer in value-based care since 1991 and has an exceptional track record of generating the very best outcomes for patients, payers, and providers. Deep clinical expertise is the foundation for every part of Paradigm’s business: risk-based clinical solutions, case management, specialty networks, home health, shared decision support, and payment integrity programs.
We are seeking a full-time, remote Senior Director Risk Actuarial Services position.
RESPONSIBILITIES:
- Manage the measuring, monitoring, and analyses of historical contract performance to ensure product profitability.
- Direct all actuarial activities, including data collection, data integrity, and actuarial and risk models.
- Effectively design and develop pricing and risk models for diagnostic specific populations.
- Effectively design and develop pricing constructs with Finance and others. This should include models that will meet the needs of all customer types and verticals, i.e., health plans, HMOs, self-insured, reinsurance, and workers compensation and be applicable across complex medical conditions including comorbidities and other risk factors.
- Provide training and development to staff on the design and development of pricing and risk models.
- Implement underwriting standards and provide recommendations for efficiencies.
- Analyze and model historical paid claims trends to support contract reserve requirements for existing booked business (in aggregate and for each product type and business line).
- Work with detailed health care claims data to build and maintain actuarial models to support operational processes.
- Provide guidance on creation of visually appealing and accurate deliverables, including self-service capabilities.
- Collaborate with key stakeholders to identify and develop business questions for analytic investigation and modeling.
Utilize applicable data/analytical tools to extract and analyze data (e.g., SAS, SQL, Excel, Power BI)
SUPERVISORY RESPONSIBILITIES:
- Mentor, train, and supervise team members directly and indirectly, review their work and provide effective constructive feedback.
- Ensure all team members understand, are trained in, and comply with Paradigm’s security requirements and policies.
- Ensure all team members have the minimum level of IT system access required to effectively complete their Paradigm responsibilities.
QUALIFICATIONS:
- Actuarial Credential (ASA required)
- 5+ years of experience collaborating with cross functional partners and presenting analytical findings to senior leadership and stakeholders.
- Advanced proficiency in MS Excel, and experience designing and running complex data programs, (e.g., extract and analyze data via R, SAS, SQL, Python, PowerBI, VBA).
- 5+ years of experience in the Healthcare, Finance, or related industry
- 5+ years of experience as a people manager with project oversight experience
- 5+ years of experience with health care claims data and analyses
- 5+ years of experience with health care claims forecasting
Paradigm believes that fostering a diverse and inclusive workplace is central to our mission of helping more people and transforming lives. We’re striving to build a culture that better reflects the society we live in and empowers our team to deliver the highest levels of compassion and care to those we serve. For us, achieving this goal requires a workforce that respectfully embraces differences and commits to positive change, creating an environment where everyone is able to bring their whole self to work.
We are an Equal Opportunity Employer and do not discriminate against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity, status as a veteran, and basis of disability or any other federal, state or local protected class.
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