Senior Healthcare Actuarial Subject Matter Expert
B
Blake Willson GroupFederal Healthcare
Remote, USFull-TimeSenior
Salary130,000 - 180,000 USD per year
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Job Details
- Experience
- 6+ years
- Required Skills
- PythonSQLMicrosoft Power BIFinancial analysisR
Requirements
- Bachelor’s degree in Actuarial Science, Mathematics, Statistics, Economics, Healthcare Analytics, or a related field.
- 6+ years of experience performing managed-care actuarial analysis for a Federal healthcare program or major payer.
- 6+ years of experience analyzing healthcare utilization, unit cost, trend, IBNR, risk adjustment, provider reimbursement, and network pricing.
- 6+ years of experience developing written actuarial findings that support proposal clarifications and negotiation positions.
- Demonstrated ability to develop, review, or validate complex healthcare cost projections.
- Strong knowledge of Actuarial Standards of Practice related to data quality, modeling, and healthcare cost estimates.
- Ability to deliver accurate, defensible actuarial products under compressed procurement timelines.
- Ability to communicate findings to technical, financial, and Government decision-makers.
Responsibilities
- Lead actuarial analysis of complex medical and dental healthcare proposals valued at nearly $1 trillion.
- Review solicitation requirements, actuarial instructions, evaluation criteria, data specifications, amendments, and Government assumptions for compliance.
- Evaluate actuarial models, rate development methodologies, utilization, unit costs, trend factors, risk adjustments, population assumptions, and provider-network impacts.
- Assess the quality, completeness, credibility, and consistency of claims, encounter, eligibility, membership, provider, and utilization data.
- Analyze key actuarial assumptions, including IBNR, seasonality, benefit changes, population mix, geographic variation, reimbursement, network discounts, credibility, and normalization.
- Independently test material calculations, models, sensitivity analyses, and scenarios for mathematical and methodological accuracy.
- Benchmark Offeror assumptions and results against historical experience, independent estimates, Government assumptions, market data, and other available benchmarks.
- Identify methodological weaknesses, unsupported assumptions, data limitations, inconsistencies, uncertainty, and potential financial or performance risks.
- Develop clarification questions and negotiation recommendations, including supporting rationale and potential financial impact.
- Prepare Price Analysis Report sections, briefings, exhibits, and negotiation-support materials.
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