Actuary - Medicare Advantage Value-Based Contracting

How Is This Role Important to Our Work?

This position applies broad actuarial principles and modeling technical skills to develop solutions to variable situations in the areas of health insurance primarily for the Medicare line of business. As a key part of the Medicare Provider Relations teams, independent actuarial analysis, actuarial judgement, and problem resolution will be critical to the performance of the Medicare Provider Network. Collaborates with and presents results of analysis and recommendations to management and other departments, including Medicare segment leadership. Provides divisional representation and may lead role corporate projects.

A Day in the Life:

• Accountable for modeling the structure and outcomes of various value-based contracting (VBC) arrangements and enablement strategies to support Medicare network reviews. Inform the Medicare VBC strategy by projecting Medicare network and provider performance and identifying revenue generating or cost saving opportunities.
• Works closely with actuarial, finance, data & analytics, stars, risk adjustment, and other lever owners to gather necessary data for modeling. Ensure inputs and assumptions leverage BCBSM source of truth/"official" estimates and are as up to date and technically sound as possible.
• Lead the modeling of Medicare financial impact and provider financials from provider enablement investments.
• Support individual provider negotiations as appropriate by assessing population-specific considerations and financial impact and tradeoffs from counterproposals. Monitor and project provider and vendor performance relative to established contracts.
• Collaborate with actuarial, finance, Medicare and risk adjustment to ensure all inputs and assumptions leverage BlueCross source of truth and to ensure all estimates are as up to date and technically sound as possible.
• Independently research, gather, analyze and interpret medical data.
• Manage end-to-end modeling and solution development life cycle from requirements gathering, identification of data sources, model development and evaluation, to data processes and model implementation.
• Understand/interpret model results and make business practice recommendations to improve pricing, risk selection, and forecasting.
• Stays up-to-date with industry trend, regulations and best practices related to Medicare value-based payment models.
• Makes satisfactory progress according to the Actuarial Student Program guidelines, if still in pursuit of actuarial accreditations.
• Other specific accountabilities as assigned by management.

Nice to Have:

• Bachelor's degree in math, statistics, actuarial science, economics or related
• FSA (Fellow of the Society of Actuaries)
• Data querying and modeling experience in cloud platforms
• Reporting experience with Power BI
• Experience in advanced programming languages including but not limited to SQL, R, or SAS

Required Skills and Experiences:

• 5+ years of related professional experience. All relevant experience including work, education, transferable skills, and military experience will be considered.
• Experience in Health Insurance or Medicare and in use of medical data
• Strong statistical analysis or actuarial work and network modeling.
• ASA (Associate of the Society of Actuaries)
• Strong oral and written communication skills
• Excellent Microsoft Excel, Word, PowerPoint skills.