Actuary - Denver Health Medical Plan (*Must Live In Or Relocate To Colorado*)

We are recruiting for a motivated Actuary to join our team! We are here for life's journey. Where is your life journey taking you? Being the heartbeat of Denver means our heart reflects something bigger than ourselves, something that connects us all: Humanity in action, Triumph in hardship, Transformation in health.

Department Managed Care Administration

Job Summary

Assist the activity of the organization's actuarial and medical economics work. Work with external teams of actuaries and analysts to complete rate filings, analysis of the local healthcare landscape, help increase risk adjustment capture and aid product teams in benefit design analysis. Helps with coaching, training, and support to educate other departments when necessary. Works with the analytics team to ensure data accuracy for rate filings and has a firm understanding of healthcare data complexity. Keeps track of the regulatory environment across multiple product lines in conjunction with the product teams to ensure that elements that might affect pricing, network strategy, and risk adjustment are considered when filing rates. Works collaboratively with the other departments to achieve alignment between rate setting and risk adjustment initiatives. Suggests strategic initiatives to lower healthcare costs, maintain quality and generate risk adjustment opportunities.

Essential Functions:

• Lead the development of product pricing and reserves for various health insurance products. (20%)
• Conduct analysis and make recommendations on rate changes, product design, and medical management policies based on data-driven insights (20%)
• Review and analyze trends in healthcare utilization, cost, and quality to identify opportunities for cost containment through contracting or care management activities. (20%)
• Manage the budget and resources of the actuarial and medical economics teams to ensure efficient and effective operation. (20%)
• Collaborate with numerous departments to develop company-wide policies and procedures related to actuarial, medical economics and risk adjustment functions. (20%)

Education:

Bachelor's degree in Economics, Statistics, Computer Science, Business, Public Health, Epidemiology, Mathematics, Risk Management, Actuarial Science, Data Analytics or related quantitative discipline required. ASA or FSA Actuarial designation required.

Work Experience:

10+ years of progressive Health Insurance Experience (Medicaid, Medicare, ACA) required and 5 years of direct experience with both MA and ACA risk adjustment required.

Licenses:

Knowledge, Skills and Abilities:

• Knowledge of health care administration, including managed care, Medicaid, Medicare, Exchange and CHP+.
• Knowledge of STARs and Risk Adjustment required.
• Skilled in analytical thinking, problem solving, and process improvement.
• Ability to grow and develop strong teams from scratch.
• Ability to simultaneously coordinate and manage several functions, programs, and projects in various stages of completion.

Shift Days (United States of America)

Work Type Regular

Salary $127,600.00 - $204,200.00 / yr

Benefits Outstanding benefits including up to 27 paid days off per year, immediate retirement plan employer contribution up to 9.5%, and generous medical plans. Free RTD EcoPass (public transportation), On-site employee fitness center and wellness classes, Childcare discount programs & exclusive perks on large brands, travel, and more, Tuition reimbursement & assistance, Education & development opportunities including career pathways and coaching, Professional clinical advancement program & shared governance, Public Service Loan Forgiveness (PSLF) eligible employer + free student loan coaching and assistance navigating the PSLF program, National Health Service Corps (NHCS) and Colorado Health Service Corps (CHSC) eligible employer.

Our Values: Respect, Belonging, Accountability, Transparency.

All job applicants for safety-sensitive positions must pass a pre-employment drug test, once a conditional offer of employment has been made.

Denver Health is an integrated, high-quality academic health care system considered a model for the nation that includes a Level I Trauma Center, a 555-bed acute care medical center, Denver's 911 emergency medical response system, 10 family health centers, 19 school-based health centers, Rocky Mountain Poison & Drug Safety, a Public Health Institute, an HMO and The Denver Health Foundation. As Colorado's primary, and essential, safety-net institution, Denver Health is a mission-driven organization that has provided billions in uncompensated care for the uninsured. Denver Health is viewed as an Anchor Institution for the community, focusing on hiring and purchasing locally as applicable, serving as a pillar for community needs, and caring for more than 185,000 individuals and 67,000 children a year. Located near downtown Denver, Denver Health is just minutes away from many of the cultural and recreational activities Denver has to offer. Denver Health is an equal opportunity employer (EOE). We value the unique ideas, talents and contributions reflective of the needs of our community. Applicants will be considered until the position is filled.