Actuary – Medical Cost Economics (Remote) at UPMC

United States

<p class="MsoNormal">UPMC Health Plan&nbsp;is seeking an&nbsp;Actuary in its Department of Health Economics! This&nbsp;credentialed&nbsp;healthcare actuary&nbsp;would&nbsp;drive&nbsp;high-visibility&nbsp;impactful&nbsp;analysis and would&nbsp;be&nbsp;responsible for&nbsp;developing and driving medical cost improvement strategies.&nbsp;This includes analyzing medical cost&nbsp;utilization&nbsp;and unit cost data,&nbsp;identifying&nbsp;top trend drivers and affordability opportunities, and presenting findings to leadership.&nbsp;</p><p class="MsoNormal">The&nbsp;Actuary&nbsp;will&nbsp;require&nbsp;a diverse set of skills and experience, including&nbsp;data and analytics&nbsp;expertise, broad-based business and health economics acumen,&nbsp;a&nbsp;strategic mindset, and an ability to influence and&nbsp;leverage&nbsp;cross-functional teams in a non-traditional actuarial environment.&nbsp;This position may&nbsp;also&nbsp;direct or supervise&nbsp;less experienced&nbsp;actuarial&nbsp;analysts&nbsp;in the performance of duties.</p><p class="MsoNormal">As an&nbsp;Actuary&nbsp;at UPMC, you will be given support&nbsp;for&nbsp;professional designations through our comprehensive student program&nbsp;and continuing education&nbsp;opportunities.&nbsp;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.<span style="font-family:&quot;Arial&quot;,sans-serif;"> </span></p><p class="MsoNormal"><strong>Responsibilities:</strong></p><ul><li><p class="MsoNormal">Lead the development of detailed actuarial and financial&nbsp;tools&nbsp;to communicate drivers of financial performance to&nbsp;facilitate&nbsp;corporate decision-making and the development of&nbsp;cost&nbsp;mitigation strategies.</p></li><li><p class="MsoNormal">Lead and support the implementation and ongoing maintenance of the HCG Grouper software, including comprehensive data validation, testing, and quality assurance activities to ensure&nbsp;accurate&nbsp;and reliable results</p></li><li><p class="MsoNormal">Support the enterprise-wide rollout of HCG Grouper data by creating documentation, providing user support, and&nbsp;facilitating&nbsp;knowledge transfer to business partners.</p></li><li><p class="MsoNormal">Analyze&nbsp;impacts&nbsp;of healthcare affordability initiatives on medical cost and&nbsp;utilization&nbsp;trends.</p></li><li><p class="MsoNormal">Apply analytical and statistical software tools to summarize large healthcare data to glean findings and actionable insights&nbsp;and deliver results to leadership.</p></li><li><p class="MsoNormal">Forecast and interpret financial results, including variances from&nbsp;budget,&nbsp;to help identify&nbsp;medical cost&nbsp;improvement opportunities and potential risks.</p></li><li><p class="MsoNormal">Analyze trends in spending and&nbsp;utilization&nbsp;using healthcare claims data.</p></li><li><p class="MsoNormal">Develop and gain support for&nbsp;data-based&nbsp;recommendations&nbsp;with team members from product, clinical, network, and strategy functions.</p></li><li><p class="MsoNormal">Guide&nbsp;the development of&nbsp;well-documented standard actuarial reports and projects.</p></li><li><p class="MsoNormal">Present results of analyses and recommendations to&nbsp;management and senior leaders.</p></li><li><p class="MsoNormal">Apply an understanding of complex actuarial concepts, methods,&nbsp;and applications in a variety of situations.</p></li><li><p class="MsoNormal">Creatively&nbsp;leverage&nbsp;a wide range of datasets to inform key analyses.</p></li><li><p class="MsoNormal">Provide direction&nbsp;and supervision&nbsp;to less experienced staff&nbsp;in the performance of duties.&nbsp;May directly manage 1 analyst.</p></li><li><p class="MsoNormal">Build strong relationships with Actuarial, Analytics, and Finance teams across the enterprise.</p></li><li><p class="MsoNormal">Ensure that departmental work products meet the highest standards of quality.</p></li><li><p class="MsoNormal">Provide analytical support for ad hoc data and analyses</p><p>&nbsp;</p></li></ul><br><br><p>•&nbsp;&nbsp;&nbsp;&nbsp;Bachelor's degree in mathematics, statistics, actuarial science, economics, or related field required.&nbsp;<br>•&nbsp;&nbsp;&nbsp;&nbsp;ASA certification by Society of Actuaries required.&nbsp;<br>•&nbsp;&nbsp;&nbsp;&nbsp;Experience in any of the following is a strong preference: Milliman HCG data, Power BI, claims-based experience analysis, trend analysis, population health, network and reimbursement analysis, &nbsp;<br>•&nbsp;&nbsp;&nbsp;&nbsp;5 years of experience in progressively more responsible actuarial work in health insurance/managed care/consulting or equivalent education.&nbsp;<br>•&nbsp;&nbsp;&nbsp;&nbsp;Experience with commercial and government health programs is preferred.&nbsp;<br>•&nbsp;&nbsp;&nbsp;&nbsp;In-depth understanding of health insurance market dynamics.&nbsp;<br>•&nbsp;&nbsp;&nbsp;&nbsp;Excellent problem-solving and analytical skills.&nbsp;<br>•&nbsp;&nbsp;&nbsp;&nbsp;Excellent oral and written communication skills.&nbsp;<br>•&nbsp;&nbsp;&nbsp;&nbsp;Adaptability and ability to prioritize effectively.&nbsp;<br><br><br><strong>Licensure, Certifications, and Clearances:</strong><br>A.S.A. or F.S.A. certification by Society of Actuaries Membership in the American Academy of Actuaries<br>&nbsp;</p><ul><li>Act 34</li></ul><p><br><strong>UPMC is an Equal Opportunity Employer/Disability/Veteran</strong></p>