The Sr. Actuarial Business Insights Analyst is an analytically heavy hands-on role, utilizing processed business information points as the basis to further define and build out actuarial metrics, KPIs and analytical models to find operational issues, predict risk scores, incidence of disease, admits, LOS, financials etc., and prescribe actions to improve KPIs and metrics. The focus of this role will be on operational and clinical KPIs and metrics, including logic definition and alignment, and using analysis and modeling to provide highly contextualized and actionable business insights to P&L owners, clinical leaders, business stakeholders and executives. A key focus area of this role will be to act as a bridge between health plan operations and its finances, authorization and claims, and accounting and finance. The Actuarial Analyst needs to be well versed in all areas of finance and accounting for health plan, provider payments, authorizations, claims, accruals, internal health plan administration costs and generating insights out of actuarial, health plan, financial and operational data.

This individual contributor role will closely collaborate with various business functions to understand their needs for actuarial and risk-based analytics. The role will be responsible for creating and maintaining claims triangles, IBNR factor, and accurately measure and predict risk-related factors for health plan operations, claims, etc. and its direct impact on the company’s IBNR accrual, reserving and finances.

Duties and Responsibilities:

• Collaborating with business stakeholders in helping identify which operational, financial and actuarial metrics are the most useful to track, how should they be defined, and how can they be improved.
• Provide ideas backed by analysis on how to improve status quo, and finding new solutions and levers to improve business and clinical efficacy.
• Building relationships and trust with business partners.
• Using data, information, analysis, and modeling to find ways to improve key metrics, optimize operations and clinical efficacy – with a keen focus on risk management, IBNR, health plan operations, claims, clinical excellence and predictive modeling.
• Partner closely with the Business Information Management function in designing business-facing semantic layers (data marts) and foundational information structures that’ll feed into risk-based analytics.
• Serve as a subject matter expert for business rules and logic (clinical and non-clinical) to convert information into operational and clinical metrics and KPIs.
• Partner with the Business Information Management team in the design and development of a single source of truth repository for the company’s clinical and operational data, especially focused on risk-based financial and accounting needs.
• Communicate effectively to business users, stakeholders and leaders on how business and clinical logic is applied to information points to arrive at key KPIs and metrics, why we’re measuring what we’re measuring, and how operational activities interlink to KPIs, OKRs etc.
• Actively participate in KPI/metrics governance.
• Work with influence, without ego and exhibit a collaborative spirit, with an unyielding motivation to do what’s best for the organization.

Qualifications and Requirements:

• Bachelor’s Degree (preferably in an analytical discipline) required.
• Minimum 4 years’ experience as a healthcare actuarial analyst, with expertise in evaluating and managing health plan operations risk, IBNR factor, predictive analysis on claims and authorization, and predicting and managing health plan ops risk
• Minimum of 4 years’ experience in business analytics, with a focus on converting business information into actionable analysis, predictive and prescriptive analytics and generating meaningful business insights
• Minimum 3 years’ experience with business information architecture, business metric governance, metric cataloging and dictionaries
• Minimum of 4 years’ experience in the healthcare industry.
• Excellent organizational and communication skills with leaders, stakeholders and users.
• Minimum 4 years’ experience with SQL, SAS, Tableau, Power BI or other analytical and business intelligence tools
• Hands-on experience with actuarial analysis design problems and varied healthcare datasets and domains (e.g. enrollment, benefits, claims, payment, clinical, risk, healthcare financials etc.)
• Ability to work independently with minimal supervision.
• Demonstrated ability to prioritize in a fast-paced environment.
• Experience and competency working with people from diverse backgrounds and cultures.
• Deep commitment to helping unlock the potential of our most vulnerable seniors.