PRIMARY FUNCTIONย
Theย Actuarialย Director,ย Reservesย is responsible forย establishingย the monthlyย accrualsย related to risk-basedย contracts. This role willย require collaboration withย cross-functional teams, including accounting, FP&A, managed care, clinical, and operations, to reconcile IBNR reserves with financial statements, provide insights into variances and trends, and consider the value of clinical initiatives on the outstanding IBNR.ย
ESSENTIAL DUTIES AND RESPONSIBILITIESย
This list may not include all of the duties that may be assigned.ย
Overseesย the monthly accrual process, ensuringย timelyย andย accurateย estimation of surplus/deficits related to risk contracts.ย ย
Collaboratesย with cross-functional teams, including accounting, FP&A, managed care, clinical, and operations, to reconcile IBNR reserves with financial statements, provide insights into variances and trends, andย consider the value of clinical initiatives on the outstanding IBNR.ย ย
The role will support the development of a reservingย methodology,ย documentationย and data validation controls.ย ย
Partneringย with Finance on financial reporting matters and audit requests.ย
Supportsย reviewing the payorโs estimated contract balance againstย accruedย balances and provide data-backed findings to theย payor, while considering the contract settlement terms.ย Role will require working directly with payors related to financial settlements and inputs to those settlements.ย
Monitorsย the sufficiency of reserves, the development of reserve ranges, and supporting recommendations on provisions for adverse deviations.ย ย
This role will involve moderately complex to complex issues where the analysis of situations requires in-depth data analysis and consideration of variable factors. Critical skills for this role willย be possessingย the ability to perform data analysis andย communicatingย the impact on the contract balances.ย ย
This role will require being flexible and a collaborative business partner in a growing organization.ย ย
SUPERVISORY RESPONSIBILITIESย
Oversee theย value-based care reserving function at Pediatric Associates.ย
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QUALIFICATIONSย
EDUCATION:ย Bachelorโs degree inย Actuarialย Science,ย Finance, Healthcare Administration orย otherย relatedย field.ย ย ย
EXPERIENCE:ย ย
LICENSUREย /ย CERTIFICATIONย
Member of the American Academy of Actuariesย
KNOWLEDGE,ย SKILLSย AND ABILITIESย
Skills to develop andย maintainย actuarial models to evaluate financial performance, risk, and opportunities associatedย with value-cased care arrangements.ย
Strongย proficiencyย in actuarial modeling software and statistical analysis tools (e.g.ย Excel, SQL, SAS, R, Python)ย
Strong communicationย skills, includingย usingย exhibits and presentations to translate technical issues for non-actuarial audiences.ย
In-depth understanding of medicalย economicsย principles, including healthcare cost analysis, reimbursement methodologies, riskย stratificationย and financial performance metrics.ย
Experience in conducting medical cost trend analysis,ย utilizationย review, and forecasting to support strategic decision-making.ย ย
Ability to think holistically through a projectย