Senior Actuarial Analyst/Actuarial Consultant

It's an exciting time to join the WellSense Health Plan, a growing regional health insurance company with a 25-year history of providing health insurance that works for our members, no matter their circumstances.

* This role involves being a consultant/analyst to the entire Actuarial team with a possibility of rotating and working on various projects and providing expertise to each of the actuarial teams, (i.e., Pricing & Reserving, Medicare Actuarial, Value Based Payments, Risk Adjustment, etc.)

Job Summary:

The Senior Actuarial Analyst is a key member of the Finance / Actuarial Services team. With minimum guidance and supervision, the Senior Actuarial Analyst applies knowledge of mathematics, probability, statistics, and principles of business in order to provide assistance and technical support for more extensive rating/pricing, reserving, medical economics, financial forecasting, and/or healthcare data analytics. The Senior Actuarial Analyst works with a team of actuaries to assure a coordinated approach to the actuarial components of health programs, and provides actuarial support to Finance, and/or other departments in the company.

Our Investment in You:

• Full-time remote work
• Competitive salaries
• Excellent benefits

Key Functions/Responsibilities:

• Analyzes financial, statistical and mathematical data and performs actuarial calculations
• Leads or supports the rate development through analyses of benefit design, rating factors, claims experience, regulatory mandates, admin expense allocation, and projection of future claim cost
• Leads or supports regulatory rate filings, and prepares data for additional inquiries and requirements
• Leads or supports the development of monthly IBNR reserve estimates for different line of business
• Prepares monthly accruals and contract settlements for different line of business
• Leads or supports financial budget, reforecast and other financial projections
• Evaluates and makes recommendations regarding the adequacy of capitation rates from state Medicaid programs or other new program
• Leads or assists in risk adjustment analyses and risk score simulations
• Leads or supports trend development, trend drivers study, and/or provider contract analytics
• Maintains established reports for internal needs or regulatory requirements
• Participates in internal and external audits
• Participates in requirements gathering for and serves as delegate or backup for corporate initiatives/projects




• Generates ideas and analytical approaches for corporate initiatives/projects




• Designs or updates SQL/SAS queries and programs to extract data from data warehouse, and reviews the data to ensure accuracy and validity
• Serves as data expert for department




• Advises Finance department on data warehouse design, requests and works with IT to establish priorities




• Initiates and leads efforts to improve quality and efficiency of actuarial models, analyses and reports
• Summarizes findings and recommendations, documents the process
• Develops presentations and communicates to senior management or external parties
• Shares knowledge and provides training to new employees

Qualifications:

Education:

• Bachelor's Degree in Mathematics, Actuarial Science, Finance, Economics or related fields

Experience:

• At least 4 years of progressively responsible experience in actuarial analysis, data modeling, informatics and analysis
• Commensurate educational experience in related field will be considered

Preferred/Desirable:

• A background in managed healthcare, insurance operations
• Master's degree
• ASA or FSA

Competencies, Skills, and Attributes:

• Should be experienced in MS Office products, SQL, and SAS or other statistical software
• Should be proficient in Excel
• Should be an experienced user of healthcare data
• Ability to meet deadlines, multi-task, problem solve and use appropriate technology to analyze business problems
• Ability to work collaboratively with team members and other departments
• Strong communications skills

About WellSense

WellSense Health Plan is a nonprofit health insurance company serving more than 740,000 members across Massachusetts and New Hampshire through Medicare, Individual and Family, and Medicaid plans. Founded in 1997, WellSense provides high-quality health plans and services that work for our members, no matter their circumstances. WellSense is committed to the diversity and inclusion of staff and their members.

Qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, disability or protected veteran status. WellSense participates in the E-Verify program to electronically verify the employment eligibility of newly hired employees