Actuarial Manager, Reserves - Pediatric Associates

Remote Opportunity

PRIMARY FUNCTION

The Actuarial Manager, Reserves is responsible for establishing the monthly accruals related to risk-based contracts. This role will require collaboration with cross-functional teams, including accounting, FP&A, managed care, clinical, and operations, to reconcile interim and final settlements to reserves with financial statements, provide insights into variances and trends, and consider the value of clinical initiatives on the outstanding reserve.

ESSENTIAL DUTIES AND RESPONSIBILITIES

This list may not include all of the duties that may be assigned.

SUPERVISORY RESPONSIBILITIES

Oversee the value-based care reserving function at Pediatric Associates.

QUALIFICATIONS

EDUCATION: Bachelor’s degree in Actuarial Science, Finance, Healthcare Administration or other related field.

EXPERIENCE:

• 7 or more years of healthcare actuarial work experience required.
• 3 years of experience in a health insurance reserving capacity.
• Experience in establishing provider contract reserves and monitoring of settlements.
• Experience in Managed Medicaid.

LICENSURE / CERTIFICATION

• ASA or FSA designation
• Member of the American Academy of Actuaries

KNOWLEDGE, SKILLS AND ABILITIES

• Skills to develop and maintain actuarial models to evaluate financial performance, risk, and opportunities associated with value-cased care arrangements.
• Strong proficiency in actuarial modeling software and statistical analysis tools (e.g. Excel, SQL, SAS, R, Python)
• Strong communication skills, including using exhibits and presentations to translate technical issues for non-actuarial audiences.
• In-depth understanding of medical economics principles, including healthcare cost analysis, reimbursement methodologies, risk stratification and financial performance metrics.
• Experience in conducting medical cost trend analysis, utilization review, and forecasting to support strategic decision-making.
• Ability to think holistically through a project

TYPICAL WORKING CONDITIONS

• Non-patient facing
• May rotate working in the office and remote.
• Must be U.S. based.

OTHER PHYSICAL REQUIREMENTS

• Vision
• Sense of sound
• Sense of touch

PERFORMANCE REQUIREMENTS

Adhere to all organizational information security policies and protect all sensitive information including but not limited to ePHI and PHI (Protected Health Information) in accordance with organizational policy, Federal, State, and local regulations.

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