Senior Actuarial Analyst
Brookfield, WI 
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Posted 27 days ago
Job Description
About us
Common Ground Healthcare Cooperative is a “who” not a “what.”  As a cooperative, we are thousands of Wisconsin residents buying health insurance together, supported by a staff focused on providing the best possible service to our members.  We are a not-for-profit cooperative, governed by a Board of Directors made up of members who purchase our health insurance.  Any earnings are returned to our members in the form of lower prices and better services.

Our Culture
We are here because we can make a difference in the lives of others.  We believe that serving our community is meaningful work and we hold it in the highest regard.  We are vibrant, dynamic, and value-focused individuals who welcome different points of view, perspectives, and thoughtful solutions to challenges.  We encourage teamwork, integrity, mutual respect, honesty and doing the right thing.  We know the importance of showing appreciation for a job well done, celebrate our achievements, and make room for fun and laughter in the workplace.

Our Job
We are continuously improving our efforts to serve our members and lower their overall healthcare cost through our three key pillars:  Advocacy – Partnership – Innovation.

              Does this sound like a culture you’d like to be a part of?   Come join a fun team of committed professionals!


How You’ll Make a Difference


The Senior Actuarial Analyst is responsible to conduct analysis of financial data to estimate revenue and IBNR for analysis and financial statements. Provides timely and accurate revenue and reserve estimates. Develops budgets and forecasts estimates for different products. Performs financial analysis of rate negotiation processes. Analyzes financial results based on past and current trends, projections and rate competitiveness for reinsurance levels. Produces medical cost reports, analyzes trends, financial reports and state filings.  Ensures compliance with all benefit requirements.


Utilize Your Skills By:

 
  • Develops pricing methodologies and assumptions for individual and small group products;
  • Performs extensive experience analysis to identify key drives of health care cost trends; makes recommendations for benefit changes;
  • Performs competitive analysis from a product and pricing perspective;
  • Performs provider contract evaluation and impact on pricing;
  • Calculates reserves for IBNR;
  • Calculates Risk Scores;
  • Completes Qualified Health Plan filing and state rate filing to include testing;
  • Ensures compliance with Essential Health Benefit requirements;
  • Collaborates with designated staff to create new products and make changes to existing products;
  • Performs small group credible coverage certifications;
  • Reviews work prepared by external consultants to ensure accuracy of data;
  • Prepares standard internal reports, ad hoc internal reports and external reports required by outside entities (i.e.  OCI, CMS, etc.).

What You’ll Need to Bring:
 
  • Bachelor's degree in Actuarial Science, Mathematics, or a related field is required
  • Associate of the Society of Actuaries (ASA) designation or Fellow of Society of Actuaries (FSA) designation preferred
  • At least 5 (five) years of experience in a combination of actuarial pricing, reserving, forecasting, financial forecasting, healthcare data analysis and healthcare pricing required
  • Problem solving, analytical ability and interpersonal skills are important to perform successfully in this position.
  • Understanding of the Affordable Care Act including: Reinsurance, Risk Corridors, and Risk Adjustment
  • Must be able to manage/supervise multiple projects and to meet established deadlines
  • Demonstrated adaptability and flexibility to new ideas and approaches
  • Experience combining clinical and financial data
  • Advanced knowledge of Excel
  • Heavy reporting experience in an insurance/healthcare or state regulatory fiscal and qualitative environment (experience commensurate in this background)
  • Maintain confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA)
  • Ability to establish and maintain positive and effective work relationships with coworkers, clients, members, providers and customers
  • Ability to  interpret, synthesize and analyze financial information and reports, metrics and other data, arrive at supportable conclusions and recommendations and present to all levels of the organization, formally and informally, at the appropriate level of the audience


We’ve Got You Covered
CGHC offers a comprehensive benefit package and broad range of programs to meet the needs of our employees to help protect your health, wealth, and future. 




 

 

Job Summary
Start Date
ASAP
Employment Term and Type
Regular, Full Time
Hours per Week
40
Work Hours (i.e. shift)
8:00am - 5:00pm
Required Education
Bachelor's Degree
Required Experience
3+ years
Security Clearance Note
Common Ground Healthcare Cooperative
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