- Identify opportunities to reduce medical expenses and collaborate with other areas to implement and monitor performance.
- Participate in product development, pricing, filing, and rating implementation of new products and strategies.
- Develop studies, analyses, and presentation materials needed to appropriately inform decision makers.
- Answer questions of less experienced staff.
- Analyze and understand hospital, professional, and drug claim/utilization trends, membership/demographics, and financial variance to budget, and performs various other ad-hoc analyses.
- Maintain appropriate controls around models and other work products.
- Ensure quality and on time completion of deliverables.
- Provide support for coordination of quarterly close activities.
- Partner with key stakeholders to develop and finalize valuation methodologies.
- Prepare and analyze results and forecasts.
- Perform monitoring processes for trends and risk valuation calculations.
- Develop efficient and transparent queries to obtain data that is appropriate to the purpose with minimal assistance and oversight.
- Make appropriate recommendations to management across teams within the actuarial department.
- Proactively ensure the internal and external consistency of all work.
- Perform reasonability checks dependent on industry knowledge and experience.
- Develop and implement analyses for special projects.
- Provide technical and analytical support for both the Actuarial department and internal partners.
- Proactively take on additional work as needed by the team.
- Perform duties and assignments as directed or required.
Requirements:
- Bachelor's degree in Actuarial Science, Mathematics, other physical science, or related finance/business degree required
- 2 or more Actuarial exams completed and passed required
- 4 - 6+ years of relevant, professional work experience and/or education required
- 1 - 2+ years health insurance actuarial experience, preferably in the managed care industry required
- Must make sufficient progress toward obtaining actuarial credentials, defined as sitting for a minimum of one exam per year, scoring above a zero, and obtaining at least a combined score of 5 over two consecutive sittings.
- When unable to meet the progress outlined in the bullet above, the role will be transitioned to a non-Actuarial job title and job description.
- Comprehensive understanding of actuarial principles and methodologies and strong mathematical and analytical skills required
- Excellent communication skills (verbal, written, presentation) required
- Strong working knowledge of MS Office including Outlook, Word, Excel, PowerPoint, etc. required
- Working knowledge of SQL, R, Python or similar required
- Capable with Excel, data extraction, simulations, automation required
- Knowledge of reimbursement methodologies required
What We Do
EmblemHealth is one of America’s largest not-for-profit health insurers, serving more than three million people in the New York tristate area. With an 80-year legacy of serving New York communities, EmblemHealth offers a full range of commercial and government-sponsored health plans to employers, individuals, and families.
We started back in the 1930s, at the height of the Great Depression. Out of hard times, the idea of health insurance was born — a system that would protect everyday people from financial misfortune if they had an accident or illness. Two companies from those early days of health insurance, Group Health Incorporated (GHI) and Health Insurance Plan of Greater New York (HIP), would later merge and become EmblemHealth. And after 80 years, our purpose as a not-for-profit is still the same — to provide quality, affordable health insurance for New Yorkers and their families.
The EmblemHealth family of companies provides insurance plans, primary and specialty care, and wellness solutions. The family of companies covers the whole health journey, starting with affordable coverage through EmblemHealth, and ConnectiCare, a leading health plan in Connecticut. The family of companies also includes medicinal practices AdvantageCare Physicians and BronxDocs, occupational health clinic EmblemHealth Health@Work, EmblemHealth Family Dental, and WellSpark Health, a barrier-breaking digital wellness company.
As a family of companies with deep community roots, EmblemHealth Neighborhood Care and ConnectiCare Centers offer free wellness and community resources. Together, the family of companies creates healthier futures for customers and communities.
We think of ourselves as an 80-year-old start-up — big enough to offer the stability and benefits of a major corporation, with a ferocious commitment to innovation, collaboration, and flexibility. We believe in what we’re doing. And we’re looking for passionate people to join us.
