Under general supervision, the Actuarial Analyst performs actuarial services in support of Health Plan operations, and monitors and maintains financial solvency through the understanding of current data & environment and modeling of future events. Interacts with internal and external departments such as Rating & Underwriting, Finance, Network Management, Provider Contracting, Health Informatics, Marketing & Sales as well as BCBSA, NYSID and CMS. Establishes insurance rates, rating structures, and rating systems for groups and categories of business. Maintains reserve programs, pricing files, benefit relativity tables and appropriate documentation for work. Develops financial projections, unpaid claim liability estimates and conducts actuarial analysis for well defined projects as directed. Compiles and analyzes data to draw conclusions and make recommendations. Proposes and assists in the development of process improvements utilizing system and software applications to full potential and participates in activities and projects as directed.
• Develops rate or Medicare bid filings through analysis of benefit designs, claims experience, and expected future events.
• Prepares accurate and timely trend analyses for lines of business.
• Develops preliminary reserve estimates for one or more blocks of business.
• Prepares data used to analyze unpaid claim liabilities for various NAIC, NYS and internal financial statements.
• Prepares and submits financial blanks and other regulatory reports required by the NAIC, NYS or BCBSA.
• Participates in regulatory/external party audits.
• Supports analysis of regulatory changes in determination of the Health Plan impact.
• Assists in the preparation of risk adjustment analyses.
• Supports higher level analysts on special projects involving other areas of the company.
• Supports analyses for other departments on various initiatives.
• Assists in performing analyses used in the development of financial plans, re-forecasts, and other financial projections.
• Assists in efforts to continually improve data capabilities and quality of department analysis and reporting.
• Assists in the development of rates, rating factors, rate filings and other rating related responsibilities.
• Assists in the implementation of regional or product line initiatives.
• Identifies, participates in and/or implements process improvement initiatives.
• Prepares and/or maintains appropriate documentation of work.
• Completes and/or supports ad hoc analyses and projects and assists others in the department as needed.
• Supports risk sharing analyses, capitation development, and associated settlements.
• Consistently demonstrates high standards of integrity by supporting the Lifetime Healthcare Companies’ mission and values and adhering to the Corporate Code of Conduct.
• Maintains high regard for member privacy in accordance with the corporate privacy policies and procedures.
• Regular and reliable attendance is expected and required.
• Performs other functions as assigned by management.
In addition to Level I responsibilities:
• Shares knowledge with newer department employees.
• Conducts analyses for other departments on various initiatives.
• Assists in the development of actuarial analyses concerning complex issues and trends, coordinates with staff.
• Analyzes and recommends reserves for one or more blocks of business.
• Identifies and develops corrective action with regards to Data Warehouse integrity issues.
• Reconciles Data Warehouse data with corporate financials.
• Initiates and leads efforts to continually improve data capabilities and quality of department analysis and reporting.
• Draws together facts and input from a variety of sources.
• Develops analyses as assigned.
In addition to Level II responsibilities:
• Ensures pricing is consistent with established profitability targets for business segments priced in Actuarial.
• Develops rates, rating factors and rate filings. Maintain rating methods and models or formulas for Commercial and Medicare lines of business.
• Recommends reserves for several blocks of business. Provide and explain analysis supporting recommendation.
• Develops actuarial analyses concerning complex issues and trends, coordinating with several different disciplines and staff.
• Provides effective technical advice and support to assist management in meeting corporate goals and identifying strategy. Involves other departmental areas as needed.
• May prepare actuarial statements of opinion.
In addition to Level III responsibilities:
• Recommends departmental annual performance goals.
• Represents the Actuarial Department on special projects involving other areas of the company or external constituents.
• Leads actuarial analyses concerning complex issues and trends, coordinating with several different disciplines and staff.
• Interprets how regulatory changes affect Health Plan and develops impact analyses.
• Provides support to assist management in meeting corporate goals and strategic decision making.
• BS in Math, Economics, Actuarial Science or allied field, minimum one year actuarial experience required or in lieu of experience, at least one actuarial exam is required.
• Continued professional growth in Actuarial field as evidenced by participation in the Actuarial Study Program preferred.
• Strong analytical skills, verbal and written communication skills.
• Strong interpersonal skills, including negotiation skills.
• Strong organizational skills and ability to prioritize, multitask, and work in fast paced environment.
• A strong understanding of health insurance & health insurance products, managed care, accounting principles, the competitive market, the legislative environment, and any regulatory issue affecting the Health Plan is expected to be acquired.
• Strong PC skills including proficiency in Microsoft Excel, Word, SAS, Cognos, and Power Point required.
• Proficiency using Milliman USA Health Cost Guidelines may be required; if so, training will be provided where necessary.
In addition to Level I qualifications:
• A minimum of :
o Three years actuarial or related insurance industry experience required or
o Two years actuarial or related insurance industry experience and two actuarial exams required.
• At least two Actuarial Exams preferred
• Highly proficient computer skills including Excel, Word, SAS, Cognos, PowerPoint
• High level understanding of non-Actuarial functions such as Rating, Underwriting, Accounting, Provider Contracting, Network Management, Product Development, Medical Management, etc., and how they impact Health Plan operations and financials.
In addition to Level II qualifications:
• A minimum of :
o Six years actuarial or related insurance industry experience required or
o Three years actuarial or related insurance industry experience and four actuarial exams is required.
• At least three Actuarial Exams preferred
• Strong ability to recognize and automate repetitive tasks
• Ability to perform complex modeling independently
In addition to Level III qualifications:
• A minimum of :
o Ten years actuarial or related insurance industry experience required or
o Four years actuarial or related insurance industry experience and ASA & MAAA credentials.
• At least four actuarial exams preferred
• A strong understanding of non-Actuarial functions such as Rating, Underwriting, Accounting, Provider Contracting, Network Management, Product Development, Medical Management, etc., and how they impact Health Plan operations and financials.
In support of the Americans with Disabilities Act, this job description lists only those responsibilities and qualifications deemed essential to the position.
Equal Opportunity Employer
Excellus BlueCross BlueShield - 17 months ago