The Actuarial Analyst 3 will be responsible for interpreting data, leveraging analytical tools and making recommendations to key stakeholder at the DVACO and Jefferson (JHS) \Mainline Health (MLH) PODs. Is seen as a subject matter expert and will lead DVACO governance committees and maintain ongoing relationships with all levels of management, key third party staff, internal constituents and external customers at participating CIN organizations to gather information, share data and effectively move projects forward. Provides supervisory guidance to less experienced analysts and proactively coaches and mentors others throughout the system.
- Ability to serve department as a subject matter expert.
- Works with Vice Presidents, Medical Directors, Clinical Operations, Finance, Network Contracting, IT and other POD departments or stakeholders.
- Provides supervisory guidance to less experienced analysts.
- Proactively coaches and mentors others throughout the system.
- Fully responsible for interpreting, organizing, executing, coordinating, evaluating, and communicating complex projects under the guidelines of leadership.
- Produces analytics used to measure and quantify DVACO and associated business partners’ experience through reporting using CMS data and other internal/external data.
- Works with the DVACO clinical and financial team to identify trends and patterns in these complex data sets, draw conclusions, develop summaries utilizing charts, graphs and images to appropriately display the information for presentations to stakeholders.
- Works with and educate the POD quality leadership, the TIN and clinical practice leadership to present statistical and operational reports of the metrics including analysis of progress towards goals and benchmarks.
- Provides analytical support (consultation, design, analysis) to business units to understand and monitor performance as it relates to cost and quality.
- Interfaces directly with customers and management to negotiate requirements (understand customer needs and provide consultation on options to best meet that need) with customers to ensure optimal value and timely delivery.
- Provides direction and/or consultation on analytical approach to peers and customers. Uses business knowledge to anticipate business questions and needs and proactively identify and implement solutions. Identifies gaps in business reporting and proactively identifies and implements solutions.
- Performs all aspects of actuarial informatics analysis including; data acquisition and data management, advanced SAS or SQL programming, advanced data visualization, quantitative and qualitative data analysis.
- Creates written narrative summaries that compliment many of the key performance indicators and metrics, or analytics outlining trends of interest, opportunities for intervention or consideration, changes or shifts in data elements from one time period to another, etc.
- Demonstrates knowledge in the relevance/importance of work and its impact on operations
- Demonstrates initiative including recommending changes for improvement opportunities.
- Independently evaluates and selects techniques, procedures
- Interprets and synthesizes outcomes and conclusions
- Participates in all required meetings, educational overview sessions, product implementation and review sessions as communicated by leadership
- Communicates effectively within informal and formal channels, including written communications, presentations and informal communications with peers, management and business partners.
- Acquires knowledge about DVACO and JHS\MLH Pods system and processes, as required to support population health reporting.
- Interacts with co-workers, visitors, and other staff consistent with DVACO values.
Primary Customers or Key Working Relationships:
DVACO Leadership, DVACO, JHS and MLH Analytics Staff, DVACO Care Coordinators, DVACO Practice Transformation Team, DVACO Operations Team, DVACO and POD Clinical teams
BS required in Business, Mathematics, IT or data relevant field
Minimum of 5 years related professional work experience in a progressive healthcare or insurance setting required. One year of experience may be granted for passage of at least one or more Society of Actuarial (SOA) exams or active in the Exam Program.
- Maintains proficiency and expertise in Health Plan data applications, state of the art business intelligence software and reporting tools that include, but are not limited to, MS SQL Server Components (Query Analyzer & coding, SSRS, Analysis Server, Stored Procedures, Jobs, and Functions), Business Objects (Tableau, Qlik, Crystal Reports, Crystal Enterprise, Crystal Analysis and OLAP), SAS, Microsoft Office (Word, Excel, PowerPoint, and Access) and grouper and predictive modeling software (3M and CGI) to prepare complex multi-factorial analysis. Synthesizes and Interprets analyses.
- Must possess a comprehensive understanding of clinical or payer operational processes and ability to evaluate impacts on data compilation and reporting.
- Knowledge of healthcare coding structures and payment methodologies.
- Advanced programming in SAS, SQL Query Construction or other programming language.
- Advanced understanding of relational database systems and uses.
- Demonstrates strong mathematical, statistical, financial, technical, interpersonal, organizational, project management skills, and ability to maintain confidentiality.
- Demonstrated strong business acumen.
- Effective verbal and written communication and presentation skills appropriate for communication with both external clients and senior management.
- Demonstrated evidence of independent analytical and problem solving skills.
- Exceptional time management and organizational skills.
- Ability to effectively handle numerous priorities simultaneously.
- Demonstrated ability to identify problem areas and take initiative to identify and implement appropriate solutions, self-motivated
Position requires the ability to manage multiple tasks in a fast moving environment.
Individual must take proper precautions as outlined in Hospital Safety Manual, Infection Control Policy and Fire and Emergency Manual.
Please apply to http://www.mainlinehealth.org/careers job id 45186. No agency calls please. Applicants must certify that they have not used tobacco products or nicotine in any form in the 90-days prior to submitting an application to Main Line Health. This will be verified during pre-employment testing.
We are an equal opportunity employer.