Purpose:
UPMC Health Plan is seeking an Actuary Specialist in its Department of Health Economics! This credentialed healthcare actuary would independently own and execute sophisticated actuarial analyses, apply industry expertise to identify opportunities, and influence strategic decisions around trend drivers. This includes leading the process of analyzing medical cost utilization and unit cost data, identifying top trend drivers and affordability opportunities, and frequently presenting findings to leadership.
The Actuary Specialist will require a diverse set of skills and experience, including data and analytics expertise, broad-based business and health economics acumen, a strategic mindset, and an ability to influence and leverage cross-functional teams in a non-traditional actuarial environment. This position may also direct or supervise less experienced actuarial analysts in the performance of duties.
As an Actuary at UPMC, you will be given support for professional designations through our comprehensive student program and continuing education opportunities. Our team members can choose a work style that is best for them - this position is eligible for fully remote work or a hybrid work arrangement for candidates based in Pittsburgh, PA.
Responsibilities:
- Drive creative problem-solving and strategic decision-making involving medical cost improvement strategies.
- Lead the development of detailed actuarial and financial tools to communicate drivers of financial performance to facilitate corporate decision-making and the development of cost mitigation strategies.
- Lead the monthly Leading Indicator process detailing emerging results and present results to clinical teams to support timely intervention and decision-making.
- Independently lead the design, development, and execution of complex actuarial analyses that translate business questions into actionable insights and strategic recommendations.
- Lead the analysis for analyzing the impacts of healthcare affordability initiatives on medical cost and utilization trends.
- Apply analytical and statistical software tools to summarize large healthcare data to glean findings and actionable insights and deliver results to leadership.
- Forecast and interpret financial results, including variances from budget, to help identify medical cost improvement opportunities and potential risks.
- Analyze trends in spending and utilization using healthcare claims data.
- Develop and gain support for data-based recommendations with team members from product, clinical, network, and strategy functions.
- Lead the development of well-documented standard actuarial reports and projects.
- Frequently present results of analyses and recommendations to management and senior leaders and lead the completion of follow-ups and next steps.
- Apply an understanding of complex actuarial concepts, methods, and applications in a variety of situations.
- Creatively leverage a wide range of datasets to inform key analyses.
- Provide direction and supervision to less experienced staff in the performance of duties. May directly manage 1 analyst.
- Build strong relationships with Actuarial, Analytics, and Finance teams across the enterprise.
- Ensure that departmental work products meet the highest standards of quality.
- Bachelor's degree in mathematics, statistics, actuarial science, economics or related field required.
- 7+ years of experience in actuarial work in a health insurance, managed care or related consulting business; or equivalent training, education and/or experience.
- Experience in any of the following is a strong preference: Power BI, claims-based experience analysis, trend analysis, population health, network and reimbursement analysis.
- Experience with commercial and government health programs is preferred.
- In-depth understanding of health insurance market dynamics.
- Excellent problem solving and analytical skills.
- Excellent oral and written communication skills.
- Strong PC skills.
- Adaptability and ability to prioritize effectively
- Data retrieval skills and relational database experience required, including SQL and/or SAS.
Data visualization experience is preferred.
Licensure, Certifications, and Clearances:
- A.S.A. or F.S.A. certification by Society of Actuaries Membership in the American Academy of Actuaries
UPMC is an Equal Opportunity Employer/Disability/Veteran