Overview
About us:
Fallon Health is a company that cares. We prioritize our members—always—making sure they get the care they need and deserve. Founded in 1977 in Worcester, Massachusetts, Fallon Health delivers equitable, high-quality, coordinated care and is continually rated among the nation’s top health plans for member experience, service, and clinical quality. We believe our individual differences, life experiences, knowledge, self-expression, and unique capabilities allow us to better serve our members. We embrace and encourage differences in age, race, ethnicity, gender identity and expression, physical and mental ability, sexual orientation, socio-economic status, and other characteristics that make people unique. Today, guided by our mission of improving health and inspiring hope, we strive to be the leading provider of government-sponsored health insurance programs—including Medicare, Medicaid, and PACE (Program of All-Inclusive Care for the Elderly)— in the region. Learn more at fallonhealth.org or follow us on Facebook, Twitter and LinkedIn.
Brief summary of purpose:
This position is responsible for providing actuarial analytic support to various departments and company key initiatives. Serves as a technical consultant and SME to financial analysts and, other departments and on projects.
Responsibilities
Major Functions (Duties and Responsibilities)
- Leads on-going analyses of financial, budgetary or medical claims data, through forecasting, statistical analyses, trending, regression analyses, risk assessment, and utilization assessment. Identifies key issues and trends and brings them to the attention of higher-level staff members. Uses professional concepts and internal policies and procedures to solve problems or provide suggestions.
- Builds financial models to support operational initiatives and analytical endeavors and enable decision-making on business and strategic matters. Quantifies the financial impact of opportunities or expenditures. Tests and reconciles all financial models and analytic results. Provides on-going financial analyses. Consolidates a wide-range of operating and financial projections for the development of short- and long-term business plans.
- Works on complex financial analysis projects more independently and under supervision of a more senior staff member if required. Monitors, analyzes and evaluates complex data using statistical tools to identify variances, problems and trends. May be responsible for bigger projects.
- Generates and distributes regularly scheduled actuarial reports. Reviews and organizes actuarial and operational data for reports. Utilizes statistical tools to monitor and provide ongoing analysis of these reports, noting any aberrant data. May be responsible in the preparation of complex reports.
- Participates in a variety of special studies and ad hoc analyses in support of departmental business and/or clinical objectives.
- Researches and resolves data integrity issues. Works independently or with other departments to solve problems.
- Acts as a resource to staff in other departments, providing information and explanations related to financial data as needed. Answers most questions and refers highly complex issues to others.
- May participate in workgroups or meetings. Communicates and presents financial analyses and models to appropriate audiences.
- May assist in training staff on the use of financial reports and data.
- Performs a variety of ad hoc data and actuarial analysis requests.
- Ability to work independently and take initiative
- Ability to identify and resolve problems, think creatively, strategically and analytically.
- Extremely organized, sharp attention to detail, strong work ethic, expansive learner. Commitment to Team Culture
- Oversees and executes projects and components of work/business processes. May integrate across business areas.
- Highly developed verbal and written skills, ability to facilitate planning and review sessions with senior FCHP management; well-developed presentation skills, presents to senior management
- Oversees, influences and resolves conflict within project team. Designs and executes a defined set of department initiatives with oversight and approval from management.
- Applies own judgment with oversight from manager on the organization and implementation of project and processes.
- Oversees and executes projects and components of work/business processes. May integrate across business areas.
- Highly developed verbal and written skills, ability to facilitate planning and review sessions with senior FCHP management; well-developed presentation skills, presents to senior management
- Oversees, influences and resolves conflict within project team. Designs and executes a defined set of department initiatives with oversight and approval from management.
- Applies own judgment with oversight from manager on the organization and implementation of project and processes.
Qualifications
Education:
- Master’s degree in related field or equivalent education or experience required
License/Certifications:
- Associate of the Society of Actuaries (ASA) or FSA designation is required
Experience:
- 4+years of responsible healthcare actuarial/analytic experience
- Healthcare and/or Medicaid experience is preferred
- SQL Programming knowledge is preferred
Fallon Health provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.