The Actuary, Analytics/Forecasting analyzes and forecasts authorization and clinical metrics understanding impacts from operational decisions and industry trends. Establishes metrics, provides data analyses, and works directly with key parties to support business intelligence. Evaluates authorizations, claims and market trends to evaluate short, medium and long-term financial impacts due to organizational initiatives. The Actuary, Analytics/Forecasting works on problems of diverse scope and complexity ranging from moderate to substantial.
The Actuary, Analytics/Forecasting ensures data integrity by developing and executing necessary processes and controls around the flow of data. Collaborates with stakeholders to understand business needs/issues, troubleshoots problems, conducts root cause analysis, and understand data anomalies. Advises executives to develop functional strategies (often segment specific) on matters of significance. Exercises independent judgment and decision making on complex issues regarding job duties and related tasks, and works under minimal supervision, Uses independent judgment requiring analysis of variable factors and determining the best course of action.
The Actuary will use information from clinical to understand the authorization process and use this understanding to analyze impacts due to operational metrics or industry changes. This person will work closely with the markets and clinical space as well as present finding to leadership.
- Bachelor's Degree
- FSA or ASA plus relevant advanced degree, recent and relevant work experience, and/or other relevant professional designations.
- Strong communication skills
- Experience with Authorization data or Claims data
- Experience with coding in SAS
- Experience in more than two functions (e.g., modeling, pricing, rate filing, reporting & analysis, reserving or trending)
- Management Experience
- Experience with both health claims and authorization data
- Skills with communicating to broad audiences