Senior Healthcare Actuarial SME

Job not on LinkedIn

🔥 13 hours ago

🇺🇸 United States – Remote

💵 $130k - $180k / year

⏰ Full Time

🟠 Senior

📊 Actuary

👻 Ghost score 0%

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Blake Willson Group, LLC

WebsiteLinkedInAll Job Openings

51 - 200 employees

🎖️ Defense

📦 Logistics

🏥 Healthcare

Defense • Logistics • Healthcare

Blake Willson Group is a company that delivers strategically focused professional services and technology solutions designed to solve complex issues faced by commercial clients, as well as federal, defense, intelligence, and civilian sectors. They specialize in government accounting, IT, and cybersecurity, offering services that include transaction processing, analytics, and professional development through their NASBA certified training programs. As a licensed CPA firm, they are recognized for delivering top-tier expertise, particularly in government accounting and grants management. Their technology solutions are tailored to meet the evolving needs of federal IT requirements, emphasizing cybersecurity maturity and software engineering. Blake Willson Group also leads the industry in grants management services, implementing processes using software as a service (SaaS) to efficiently manage the grants lifecycle and improve financial outcomes for government entities.

📋 Description

• Lead actuarial analysis of complex medical and dental healthcare proposals valued at nearly $1 trillion • Review solicitation requirements, actuarial instructions, evaluation criteria, data specifications, amendments, and Government assumptions for compliance • Evaluate actuarial models, rate development methodologies, utilization, unit costs, trend factors, risk adjustments, population assumptions, and provider-network impacts • Assess the quality, completeness, credibility, and consistency of claims, encounter, eligibility, membership, provider, and utilization data • Analyze actuarial assumptions including IBNR, seasonality, benefit changes, population mix, geographic variation, reimbursement, network discounts, credibility, and normalization • Independently test material calculations, models, sensitivity analyses, and scenarios for mathematical and methodological accuracy • Benchmark Offeror assumptions and results against historical experience, independent estimates, Government assumptions, market data, and other benchmarks • Identify methodological weaknesses, unsupported assumptions, data limitations, inconsistencies, uncertainty, and potential financial or performance risks • Develop clarification questions and negotiation recommendations with supporting rationale and potential financial impact • Prepare Price Analysis Report sections, briefings, exhibits, and negotiation-support materials • Update analyses through proposal revisions and negotiations while maintaining traceable workpapers, applying applicable actuarial standards, and protecting sensitive information

🎯 Requirements

• Bachelor’s degree in Actuarial Science, Mathematics, Statistics, Economics, Healthcare Analytics, or a related field • 6+ years of experience performing managed-care actuarial analysis for a Federal healthcare program or major payer, including proposal, bid, or rate-submission evaluation • 6+ years of experience analyzing healthcare utilization, unit cost, trend, IBNR, risk adjustment, provider reimbursement, and network pricing • Demonstrated experience developing, reviewing, or validating complex healthcare cost projections • 6+ years of experience developing written actuarial findings supporting proposal clarifications and negotiation positions • Currently authorized to work in the United States on a full-time basis • Ability to obtain a Public Trust Security Clearance

🏖️ Benefits

• Major medical benefits, including dental and vision coverage • 401(k)-contribution plan • Holiday and personal time off • Professional development training and certification benefits • Health and wellness subsidies • Paid time off for community service • Comprehensive Total Rewards package • Reasonable accommodations may be provided for individuals to perform essential job functions