Actuary, Senior

Company: Careoregon
Location: Portland
Posted on: June 4, 2025

Job Description:

Candidates hired for remote positions must reside in Oregon, Washington, Utah, Idaho, Arizona, Nevada, Texas, Montana, or Wisconsin.Job TitleActuary, SeniorRequisition #24950Exemption StatusExemptManagement Leveln/aDirect Reportsn/aManager TitleActuarial Services ManagerDepartmentFinancePay and BenefitsEstimated hiring range $135,420 - $165,520 / year, 5% bonus target, full benefits. www.careoregon.org/about-us/careers/benefitsPosting NotesThis role is fully remote but you must reside in one of the listed 9 states.Job SummaryThis senior level position is responsible for performing a wide variety of financial and actuarial analyses impacting strategic decision making and the companys financial sustainability efforts. Areas of analysis include cost and utilization trend analysis, return on investment evaluations, Medicare bid development, rate setting optimization, forecasting support, benchmarking, risk adjustment optimization, provider payment evaluation and review of actuarial estimates such as IBNR and PDR. This position provides financial stewardship by identifying opportunities for improved financial performance.Essential ResponsibilitiesFinancial and Actuarial AnalysesDrill down into cost and utilization trends to identify key drivers.Develop profitability analytics to support evaluation by provider group, contract, and other valued indicators.Design, develop, and implement evaluation tools in measuring the effectiveness of programs and payment models.Develop cost savings calculators for use in goal setting, budgeting, and forecasting.Provide rate setting support through data analysis, policy review and strategy development.Identify any actuarial unsound adjustments to the rates.Provide medical cost and utilization trend recommendations for forecasting purposes.Gather and develop benchmarks for purposes of assessing our performance and the potential for improvement.Monitor risk adjustment applied to capitation revenue and ensure population risk is appropriately represented in encounter data.Evaluate provider payment models, including risk share arrangements, to ensure they achieve the desired outcome.Prepare regular risk share reporting for sharing with providers and supporting accounting estimates.Drive strategic use of data to support business efficiencies and competitive decision-making.Review and provide guidance on actuarial estimates of IBNR, PDR and other actuarially determined assets and liabilities.Coordinate and review the work of outside actuaries to facilitate access to plan information necessary to support their work and ensure the companys interests are represented.Financial Analytical Capacity and CapabilityWork with Information Systems to ensure access to a data source with high data integrity.Work collaboratively with the Business Intelligence department and other analysts to share best practices around using the data, ensure strong data governance and maintain a community of practice resource.Provide training and support to other Finance users around the data, software, and analytic approaches.AdministrationParticipate in 1:1, team, and department meetings.Attend All Staff meetings.Draft, recommend, and implement plans, policies, and procedures.Participate in Actuarial Services team goal setting.Train, mentor, and evaluate performance of assigned actuarial staff.Organizational ResponsibilitiesPerform work in alignment with the organizations mission, vision and values.Support the organizations commitment to equity, diversity and inclusion by fostering a culture of open mindedness, cultural awareness, compassion and respect for all individuals.Strive to meet annual business goals in support of the organizations strategic goals.Adhere to the organizations policies, procedures and other relevant compliance needs.Perform other duties as needed.Experience and/or EducationRequiredAssociate of the Society of ActuariesMinimum 5 years experience in an actuarial roleWork experience in health insurancePreferredFellow of the Society of ActuariesWork experience in Medicaid or MedicareKnowledge, Skills and Abilities RequiredKnowledgeWorking knowledge of other MS tools, including MS Office products, MS AccessStrong understanding of data systems and sources and how it impacts the data availableKnowledge of medical claims, billing practices and health insurance requirementsSkills and AbilitiesStrong data management skillsProficiency in SAS, SQL, or similar database querying toolsProficiency in MS ExcelHighly effective communication skills, including listening, verbal, and writtenWillingness to acquire new skillsAbility to effectively lead and participate on a variety of large projects, including complex initiatives across departmentsAbility to identify, implement, and lead process improvementsStrong ability in articulating and presenting information across multiple areas of the organizationAbility to communicate and present to external parties (e.g., auditors, actuaries, regulatory agencies) and stakeholders (e.g., Finance committees, Board of Directors, etc.)Ability to collaborate effectively with department managementStrong attention to detail and accuracyAbility to produce high quality outputAbility to effectively review others workAbility to identify problem, inconsistencies, unexpected results, relevant information, and uncertaintiesAbility to interpret and analyze information and implement conclusions/solutionsAbility to assist team members in developing conclusions and solutionsAbility to effectively prioritize own work and complete tasks on timeAbility to effectively collaborate with coworkers, leaders, executives, and stakeholdersAbility to learn from feedback and embrace changePossess a high degree of initiative, motivation, and professionalismAbility to maintain a positive attitudeAbility to work effectively with diverse individuals and groupsAbility to learn, focus, understand, and evaluate information and determine appropriate actionsAbility to accept direction and feedback, as well as tolerate and manage stressAbility to see, read, and perform repetitive finger and wrist movement for at least 6 hours/dayAbility to hear and speak clearly for at least 3-6 hours/dayWorking ConditionsWork Environment(s): Indoor/Office Community Facilities/Security Outdoor ExposureMember/Patient Facing: No Telephonic In Person Hazards: May include, but not limited to, physical and ergonomic hazards.Equipment: General office equipmentTravel: May include occasional required or optional travel outside of the workplace; the employees personal vehicle, local transit or other means of transportation may be used.Work Location: Work from home#MULTICandidates of color are strongly encouraged to apply. CareOregon is committed to building a linguistically and culturally diverse and inclusive work environment.Veterans are strongly encouraged to apply.We are an equal opportunity employer. CareOregon considers all candidates regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, genetic information, disability, or veteran status.Visa sponsorship is not available at this time.by Jobble

Keywords: Careoregon, Hillsboro , Actuary, Senior, Accounting, Auditing , Portland, Oregon