City/State

Gainesville, FL

Overview

Work Shift

First (Days) (United States of America)

AvMed, a division of Sentara Health Plans in the Florida market, is hiring an Actuarial Analyst II in Miami or Gainesville Florida. This is a hybrid position, 2 days in office and 3 days remote if within local market or 100% remote if outside of local territory.

Scope of the position: Assist in any and all of the functions normally associated with a qualified health actuary including: IBNR calculation; the determination of rating factors such as age, sex, location, or industry; development of rates and filings for the OIR ; suggestions for periodic group rating changes; development of necessary rates for government programs; assistance with the development, implementation and maintenance of new products, services and systems, including any necessary rate development; providing actuarial input to the Corporate management staff level; and reporting on the financial status of entire products or segments of products.

ESSENTIAL JOB FUNCTIONS:
* Assists in and takes ownership of the assessment of feasibility, anti-selection risk, marketability, alternative product options, existing product options, improvements, market needs, configuration issues, and portfolio placement of new products.
* Develops and analyzes financial projections.
* Assists in and takes ownership of the development of risk adjustment projections for both the Commercial and Medicare product line.
* Provides assistance to underwriters and marketing in valuing groups' benefit changes.
* Interacts with consulting actuaries in the production and review of regulatory filings and related analyses.
* Assists and participates in negotiations and sales presentations with customers where appropriate.
* Researches, evaluates and analyzes medical care costs trends by region, market segment and product line and conduct variance analysis with respect to utilization and unit costs.
* Provides support in the development of operational systems and reporting tools for use by the Commercial Group Underwriting Unit to include automated excel-based rating programs and other actuarial tools used within the department.
* Assists in and takes the ownership of the development of underwriting guidelines and policies conducive to profitability and the avoidance of adverse selection.
* Assists in and takes the ownership of the unit Manager with the coordination of all regulatory audit activities for the Underwriting and Financial Department, including DFS Market Conduct Exams, Medicare ACR audit and OPM audit.
* Performs additional duties and responsibilities as assigned by management

Minimum Requirements:
* Bachelors Mathematics, Economics, Actuarial Services or related field.
* Minimum 2 years in Actuarial Analysis. Analytical and problem-solving skills are necessary; ability to work under tight deadlines and handle pressure situations; ability to work in a team environment.
* Minimum completion of three Actuarial exams with continued progress towards Society of Actuaries credential.
* Experience in at least 3 of the following areas:
- IBNR and reserve setting
- General pricing and filing support of Individual products
- General pricing and filing support of Small Group products
- General pricing and filing support of Large Group products
- Assist in Medicare Advantage Bid filing
- Evaluation of Managed Medicaid programs
- Provider Contract evaluations
- Provider Profit/withhold settlement evaluations
- Product Experience Monitoring
- Reinsurance/Stop-loss Reporting
* 2 to 3 years of Experience working with risk models, mathematical or actuarial analysis, preferably in a health insurance field. Successful completion of at least three Society of Actuaries examination required.

Preferred Requirements:
* Automated or Statistical Analysis Tools
* Microsoft Office Suite (Excel, Word, PowerPoint, Access)
* Analytical and Problem Solving

This position is 100% Remote but candidates must have a current residence in one of the following States or be willing to relocate- Alabama, Delaware, Florida, Georgia, Idaho, Indiana, Kansas, Louisiana, Maine, Maryland, Minnesota, Nebraska, Nevada, New Hampshire, North Dakota, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Washington (state), West Virginia, Wisconsin, Wyoming

Our Benefits:
As the third-largest employer in Virginia, Sentara Health was named by Forbes Magazine as one of America's best large employers. We offer a variety of amenities to our employees, including, but not limited to:
* Medical, Dental, and Vision Insurance
* Paid Annual Leave, Sick Leave
* Flexible Spending Accounts
* Retirement funds with matching contribution
* Supplemental insurance policies, including legal, Life Insurance and AD&D among others
* Work Perks program including discounted movie and theme park tickets among other great deals
* Opportunities for further advancement within our organization
Sentara employees strive to make our communities healthier places to live. We're setting the standard for medical excellence within a vibrant, creative, and highly productive workplace. For information about our employee benefits, please visit: Benefits - Sentara (sentaracareers.com)
Join our team! We are committed to quality healthcare, improving health every day, and provide the opportunity for training, development, and growth!
Note: Sentara Healthcare offers employees comprehensive health care and retirement benefits designed with you and your family's well-being in mind. Our benefits packages are designed to change with you by meeting your needs now and anticipating what comes next. You have a variety of options for medical, dental and vision insurance, life insurance, disability, and voluntary benefits as well as Paid Time Off in the form of sick time, vacation time and paid parental leave. Team Members have the opportunity to earn an annual flat amount Bonus payment if established system and employee eligibility criteria is met.
Keywords: Talroo-health Plan, #Indeed, Risk Models, Pricing, Health Insurance

Job Summary

Assist in any and all of the functions normally associated with a qualified health actuary including: IBNR calculation; the determination of rating factors such as age, sex, location, or industry; development of rates and filings for the BOI; suggestions for periodic group rating changes; development of necessary rates for government programs; assistance with the development, implementation and maintenance of new products, services and systems, including any necessary rate development; providing actuarial input to the Corporate management staff level; and reporting on the financial status of entire products or segments of products.
Minimum 2 years in Actuarial Analysis. Analytical and problem-solving skills are necessary; ability to work under tight deadlines and handle pressure situations; ability to work in a team environment. Minimum completion of three Actuarial exams with continued progress towards Society of Actuaries credential.
Experience in at least 3 of the following areas:
- IBNR and reserve setting
- General pricing and filing support of Individual products
- General pricing and filing support of Small Group products
- General pricing and filing support of Large Group products
- Assist in Medicare Advantage Bid filing
- Evaluation of Managed Medicaid programs
- Provider Contract evaluations
- Provider Profit/withhold settlement evaluations
- Product Experience Monitoring
- Reinsurance/Stop-loss Reporting

Qualifications:

BLD - Bachelor's Level Degree (Required)

Skills

Sentara Healthcare prides itself on the diversity and inclusiveness of its close to an almost 30,000-member workforce. Diversity, inclusion, and belonging is a guiding principle of the organization to ensure its workforce reflects the communities it serves.

Per Clinical Laboratory Improvement Amendments (CLIA), some clinical environments require proof of education; these regulations are posted at ecfr.gov for further information. In an effort to expedite this verification requirement, we encourage you to upload your diploma or transcript at time of application.

In support of our mission "to improve health every day," this is a tobacco-free environment.