Job Title:
Managed Care Actuary
Job ID:
Shared Services
Managed Care
Full/Part Time:
FTE %:
Salary Range Min:
Salary Range Max:

Position summary

Managed Care Actuary (Job Opening 424145) - Position Summary
The Managed Care Actuary is responsible for supporting managed care contract negotiations for professional and facility services by: analyzing existing and proposed reimbursement terms, analyzing contract performance, recommending reimbursement terms, updating and maintaining managed care contract management systems, and investigating and making recommendations regarding the new reimbursement structures. This position performs complex level of analysis, forecasting, and strategy development. Position works with multiple large data sets to perform data analysis. The Managed Care Actuary also performs ad-hoc analysis and may prepare written reports/recommendations and/or oral presentations related to analysis performed.

Typical activities include financial analysis, complex rate modeling, what-if analysis, database querying and report writing, interpreting reimbursement terms specified in agreements, data entry, writing SQL rules, trouble-shooting issues related to reimbursement, generating contract performance reports, preparing executive summaries, trending data, investigating reimbursement for new services, and researching hospital and professional billing and/or coding policies.

Education and experience

Bachelors degree in Actuarial science or an equivalent combination of education and experience; demonstrated experience (minimum 3 years) performing financial analysis, preferably in a health care setting; expertise with word-processing, spreadsheet, and database software required; knowledge and understanding of database structures preferred; experience with UNIX and SQL preferred, experience in a health care setting or managed care organization preferred.

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