Under general direction, performs financial projections and actuarial analysis for multiple projects or complex assignments. Recommends policies to safeguard the organization’s financial integrity. May provide oversight and guidance to lower-level actuarial staff. Pursuit of actuarial exams is not required.

Pricing, Risk Adjustment & Cost of Care Analytics

• Serve in a pre-management capacity for rate filings and pricing exercises.
• Analyze risk adjustment revenue impacts for both Medicare Advantage and Commercial business
• Perform cost of care analytics to evaluate medical trends, utilization patterns, and unit costs.
• Complete pricing exercises independently, draw conclusions, and provide actionable recommendations.
• Take ownership of deliverables, ensuring accuracy and clarity of results for both junior staff and management.

Forecasting & Healthcare Economics

• Lead the development and completion of company forecasts, integrating healthcare economic factors such as cost trends, reimbursement structures, and utilization drivers.
• Analyze outcomes, identify improvements, and communicate findings to staff and leadership.
• Recommend adjustments based on economic, regulatory, and market shifts.

Revenue Analytics & Reserving

• Take ownership of the monthly reserve process, including setting reserve cells and generating reports.
• Conduct revenue analytics to evaluate financial performance, revenue cycle drivers, and premium adequacy.
• Verify results, diagnose issues, and propose solutions.
• Present findings and conclusions clearly to both junior staff and management.

Data Analytics

• Lead analysis of data prepared by junior staff across pricing, forecasting, reserving, and revenue functions.
• Validate accuracy, identify key issues, and provide actionable insights.
• Translate findings into business impacts and recommendations for leadership.

Management Reporting

• Own the timely preparation of management reports, including cost, revenue, and utilization metrics.
• Ensure accuracy, make necessary updates, and resolve issues as they arise.
• Provide meaningful explanations of results to both staff and senior leaders.

Customer Service

• Act as a primary actuarial contact for internal and external stakeholders.
• Communicate actuarial, cost of care, and financial findings in clear business terms.
• Build relationships with internal partners and serve as a representative voice for the actuarial function.

Mentoring & Development

• Mentor junior actuarial staff and interns, teaching core principles and problem-solving techniques.

Skills

• Strong analytical and problem-solving skills.
• Advanced mathematical and statistical abilities.
• Detail-oriented with high accuracy.
• Ability to manage moderately complex issues with technical expertise.
• Effective communication skills for technical and non-technical audiences.

Knowledge

• Actuarial methods across pricing, forecasting, and reserving.
• Statistical modeling and analysis.
• Data management and technical tools.
• Healthcare economics and financial performance analysis.

Experience

• 10+ years of actuarial experience.
• Demonstrated expertise in cost of care analytics, revenue analytics, and healthcare economics.
• Experience validating financial models, conducting reserve analysis, and developing forecasts.
• Proven ability to translate technical findings into business insights and recommendations.

Education

• Bachelor’s degree in Mathematics, Statistics, Computer Science, Actuarial Science, or related field

Physical Demands:

• While performing the duties of the job, the employee is frequently required to sit, use hands and fingers, talk, hear, and see.
• The employee must be able to work over 40 hours per week.
• The employee must occasionally lift and/or move up to 5 pounds.

We recognize that work is a part of life, not separate from it, and foster a flexible environment where your health and wellbeing are prioritized. At Capital you will work alongside a caring team of supportive colleagues and be encouraged to volunteer in your community.  We value your professional and personal growth by investing heavily in training and continuing education, so you have the tools to do your best as you develop your career. And by doing your best, you’ll help us live our mission of improving the health and well-being of our members and the communities in which they live.