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CareFirst BlueCross BlueShield Actuarial Assistant in Owings Mills, Maryland

Resp & Qualifications

PURPOSE:

Actuarial responsibilities may range depending upon reporting structure, individual skillsets, and business needs. A list of potential responsibilities is as follows:

• Assist with understanding risk adjustment methodologies and usages within the organization including HHS-HCC, CMS-HCC, DxCG, PRB, CDPS-RX, and Johns Hopkins ACG.

• Assist with understanding the impact of value-based contracts (VBC) and other provider contracting arrangements and support ongoing provider negotiations.

• Assist with estimating regulatory program financial impacts, including the risk adjustment program.

• Assist with the development of rate filings for all lines of business, including ACA compliant products and grandfathered legacy products.

• Assist with the reconciliation and pricing of federal programs, including the Federal Employee Health Benefits Program and Medigap.

• Assist with the development and recording of outstanding incurred claims liabilities.

• Assist with understanding medical trend development and drivers, including drill-down analysis and reporting.

PRINCIPAL ACCOUNTABILITIES : Under general supervision, the incumbent’s accountabilities include, but are not limited to, the following:

Pricing/Reserving/Analytics. Utilizing pricing/reserving/reporting tools in order to:

• Evaluate new/existing provider partnerships, including developing/enhancing financial models related to value-based contracting (VBC) agreements. Support ongoing provider negotiations.

• Support rate filings and rating methods, including risk adjustment reporting and analytics.

• Provide general analysis of historic claim costs and projections.

• Provide sales and underwriting support related to customer requests and proposed benefit changes.

• Demonstrate an understanding of applicable Healthcare Reform laws and regulations.

• Calculate and document incurred but not reported (IBNR) reserves.

• Analyze key drivers of medical trend.

• Effectively and accurately validate external data sources.

• Develop, maintain, and potentially improve standing reports.

• Use actuarial assumptions and methodologies to develop recommendations to share with actuarial leadership.

Documentation

• Document assumptions and calculations appropriately.

• Support audit/regulatory requests for documentation or development of assumptions.

Communication

• Effectively communicate complex ideas in an easy to consume way, both to actuaries and non-actuaries

• Develop effective non-verbal communication skills to illustrate conclusions, for example graphs in Excel.

Professionalism

• Hold self and others to highest standards of professionalism, including but not limited to communication, documentation, and work product.

• Comply with all applicable Actuarial Standards of Practice.

• Comply with all company policies, including but not limited to policies regarding work and break times, appropriate use of technology, etc.

QUALIFICATION REQUIREMENTS:

Required: The Candidate must have a BA or BS degree in mathematics, finance, economics, actuarial science or related field. Active pursuit of Associate, Society of Actuaries designation required.

Abilities/Skills:

This individual must be familiar with actuarial, mathematical, and statistical procedures and practical applications. Candidate must be highly analytical and have a general understanding of health insurance products and markets. Must be detail-oriented and able to develop and implement solutions to complex problems. Incumbent must have strong PC skills, including Excel and Access or SQL. Strong communication (written and verbal), interpersonal and customer service skills are a must. This position requires someone who can work independently in a fast paced, deadline-oriented environment. Candidate must also be a fast learner and proactive problem solver. Creativity is desirable.

Must be able to meet established deadlines and handle multiple customer service demands from internal and external customers, within set expectations for service excellence. Must be able to effectively communicate and provide positive customer service to every internal and external customer.

Preferred: The Candidate is preferred to have a minimum of 2 Actuarial exams passed and at least 2-3 years of health actuarial experience.

Department

Department: Actuarial Medical Economics

Equal Employment Opportunity

CareFirst BlueCross BlueShield is an Equal Opportunity (EEO) employer. It is the policy of the Company to provide equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information.

Hire Range Disclaimer

Actual salary will be based on relevant job experience and work history.

Where To Apply

Please visit our website to apply: www.carefirst.com/careers

Closing Date

Please apply before: 7/10/21

Federal Disc/Physical Demand

Note: The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes him/her ineligible to perform work directly or indirectly on Federal health care programs.

PHYSICAL DEMANDS:

The associate is primarily seated while performing the duties of the position. Occasional walking or standing is required. The hands are regularly used to write, type, key and handle or feel small controls and objects. The associate must frequently talk and hear. Weights up to 25 pounds are occasionally lifted.

Sponsorship in US

Must be eligible to work in the U.S. without Sponsorship

REQNUMBER: 14860

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