Fully Remote
SelectHealth - Murray
Full time
R178106
Job Description:
This position provides actuarial expertise and contributes to the financial soundness of Select Health and Intermountain. Applies actuarial principles to oversee the calculation and management of financial, ACA, Medicare, Medicaid, provider contracting and pharmacy departments within the Actuarial Department. This position is regarded as an 'expert' in financial analysis and understands the interrelationship of functional and finance areas within the company. Coordinates with the CFO, Controller and others to ensure accurate and timely completion of all financial activities.
Essential Functions
One or more of the following areas of actuarial expertise:
This position reports to the Chief Actuary of Select Health. The position also has a strong working relationship with AVPs and regional leaders.
Contributes to the financial soundness of Select Health and Intermountain. Applies actuarial principles to oversee the calculation and management of financial statements, develop monthly IBNR reserves and other liabilities, actuarial forecasting models, management reporting, dynamic planning, and actuarial information for internal and external audits. Develops the actuarial portion of the annual statement.
Coordinates corporate trends and presents them to various committees.
Expertise with the development and submission of ACA filings, assists leadership with ACA strategy, responsible for ACA risk adjustment accruals, expert knowledge of ACA state and federal rules and regulations, competitive positioning, and MLR management.
Provider contracting and value-based arrangement strategy and analytical expertise. Helps inform and set strategy for the provider contracting department and provider negotiations. Expertise with transparency data and summarizing provider contracts to inform pricing actuaries of the expected medical expense component for premium development.
Directs the team in Medicare bid filing development and submissions to CMS, certifies the bid submission in HPMS, develops and coordinates management reporting, conducts in-depth Medicare financial analysis, and is responsible for appropriate accruals. Assists the risk adjustment department with strategy and data analysis.
Oversees the state Medicaid actuarial analysis and negotiations, develops and coordinates management reporting, and conducts Medicaid financial analysis.
Actuarial expertise with fully insured large group, self-funded products, stop-loss rate setting, analysis of commercial group products, interaction with underwriting and the sales team, develops actuarial factors used by the underwriting department for quoting groups, evaluates trends, admin, manual rates, and assists leadership with commercial group strategy. Acts as the point of contact for the designated senior business leader.
Develops and maintains pricing models for pharmacy benefits, conducts financial forecasts, and ensures compliance with regulatory standards. Analyzes cost and utilization data for pharmacy services, supports strategic decision-making, and collaborates with stakeholders to optimize pharmacy benefit offerings. Ensures the financial sustainability of pharmacy plans through accurate financial projections and strategic alignment.
Skills
Leadership
Management Presentations
Rate filings
Medicare Bids
Medicaid Expertise
Reserving
Provider Contracting Expertise
Communication of results
ACA expertise
IBNR Development
Qualifications
Bachelor's degree in math, statistics, computer science, economics or finance obtained through an accredited institution.
Fellow of the Society of Actuaries (FSA)- and -Member of American Academy of Actuaries or Society of Actuaries and 12 years of relevant actuarial or Associate of the Society of Actuaries (ASA)- and -Member of American Academy of Actuaries and 14 years of relevant actuarial
Understanding of underlying theory and effects of assumptions used in product development and maintenance. Knowledge of health insurance products.
4 years actuarial managerial experience.
Physical Requirements
Interact with others requiring employee to verbally communicate as well as hear and understand spoken information.
Operate computers, telephones, office equipment, and manipulate paper requiring the ability to move fingers and hands.
See and read computer monitors and documents.
Remain sitting or standing for long periods of time to perform work on a computer, telephone, or other equipment.
Location:
SelectHealth - Murray
Work City:
Murray
Work State:
Utah
Scheduled Weekly Hours:
40
The hourly range for this position is listed below. Actual hourly rate dependent upon experience.
$78.66 - $121.47
We care about your well-being - mind, body, and spirit - which is why we provide our caregivers a generous benefits package that covers a wide range of programs to foster a sustainable culture of wellness that encompasses living healthy, happy, secure, connected, and engaged.
Learn more about our comprehensive benefits package here (https://intermountainhealthcare.org/careers/benefits) .
By applying for a position with Intermountain, I acknowledge that I will comply with all applicable Intermountain policies and expectations. If applying for a remote or hybrid role, this includes remote work expectations related to confidentiality, information security, work schedules, conflicts of interest, and use of company equipment. I further acknowledge that outside employment or activities may not interfere with job responsibilities or create a conflict of interest with Intermountain. Actual or reasonably perceived conflicts may be grounds for disqualification from consideration or, if hired, corrective action up to and including termination of employment.
Intermountain Health is an equal opportunity employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, age, sex, sexual orientation, gender identity, national origin, disability or protected veteran status.
At Intermountain Health, we use the artificial intelligence ("AI") platform, HiredScore to improve your job application experience. HiredScore helps match your skills and experiences to the best jobs for you. While HiredScore assists in reviewing applications, all final decisions are made by Intermountain personnel to ensure fairness. We protect your privacy and follow strict data protection rules. Your information is safe and used only for recruitment. Thank you for considering a career with us and experiencing our AI-enhanced recruitment process.
All positions subject to close without notice.
Headquartered in Utah with locations in six primary states and additional operations across the western U.S., Intermountain Health is a nonprofit system of 34 hospitals, 400+ clinics, a medical group of more than 4,800 employed physicians and advanced care providers, a health plan division called Select Health with more than one million members, and other health services. Helping people live the healthiest lives possible, Intermountain is widely recognized as a leader in clinical quality improvement and efficient healthcare delivery.
Join our world-class team and embark on a career filled with opportunities, strength, innovation, and fulfillment.
To find out more about us, head to our career site here (https://intermountainhealthcare.org/careers/?utm\source=Workday&utm\medium=Redirect&utm\campaign=CareerHome\workday) .
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Introduce yourself to our Talent Acquisition team and we will get in touch if there is a role that seems like a good match.
Intermountain Health's PEAK program supports caregivers in the pursuit of their education goals and career aspirations by providing up-front tuition coverage paid directly to the academic institution. The program offers 100+ learning options to choose from, including undergraduate studies, high school diplomas, and professional skills and certificates. Caregivers are eligible to participate in PEAK on day 1 of employment. Learn more. (https://intermountainhealthcare.org/careers/working-for-intermountain/employee-benefits/peak-program/)
The primary intent of this job description is to set a fair and equitable rate of pay for this classification. Only those key duties necessary for proper job evaluation and/or labor market analysis have been included. Other duties may be assigned by the supervisor.
All positions subject to close without notice.
Thanks for your interest in continuing your career with our team!
