About the Role:
AsDirector, Actuarial Services you will combine your leadership capabilities and actuarial expertise to lead an actuarial team to conduct and present analytics on several business-critical initiatives. This position will be instrumental in supporting a value-based care business model for the pediatric Medicaid population. Key projects will include value-based care target-setting, savings calculations, monthly close processes, development and application of IBNR estimates, and reporting/presenting financial and clinical results drivers that Imagine Pediatrics brings to its current and prospective member base and payer clients.Primary functions and responsibilities of this role will include but are not limited to:
- Lead efforts in establishing value-based care targets (total cost of care, utilization, etc.).
- Develop a process and internal capabilities to measure the performance of value-based / shared savings arrangements and communicate valuable insights to key stakeholders.
- Oversee monthly development and application of IBNR estimates.
- Apply your knowledge of Medicaid reimbursement components and healthcare claims data to assist with the development and ongoing execution of cost and revenue forecasting models.
- Partner with the Healthcare Economics (claims data analytics) team to demonstrate value our clients achieve with Imagine through the reporting of revenue / risk score trends, healthcare utilization trends, and financial savings.
- Analyze profitability by duration, acuity, and resource allocation to inform strategic recommendations to senior leadership.
- Work closely with other finance teams to monitor performance against forecasts, analyzing and explaining drivers of variances from revenue, cost, and membership.
- Prepare analyses for shared savings settlement discussions with payer partners.
About You
First and foremost, you’re passionate and committed to creating the world our sickest children deserve. You want an active role in building a diverse and values-driven culture. Things change quickly in a start-up environment; you accept that and are willing and able to react quickly to time-sensitive needs of the business with agility and accuracy. In this role, you will need:
- Associate or Fellow of the Society of Actuaries
- Bachelor’s degree
- Minimum of 8 years of health actuarial experience with significant experience in Medicaid products, experience with value-based reimbursement strategies and affordability initiatives preferred
- Prior leadership experience with demonstrated ability to both lead and execute
- Ability and willingness to train and transfer knowledge to junior level staff
- Actuarial knowledge of best practices for evaluation, modeling (cost, risk score and revenue) and analytics
- Strong SQL skills
- Ability to work effectively in a dynamic and fast-paced environment
- Strong communicator (both written and verbal) with an ability to break down complex and technical concepts in an easy-to-understand way
- Strong organizational, documentation and problem-solving skills
- Strong business acumen and interpersonal skills
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