Senior Healthcare Actuarial SME

Job not on LinkedIn

🔥 0 minutes ago

🇺🇸 United States – Remote

💵 $130k - $180k / year

⏰ Full Time

🟠 Senior

📊 Actuary

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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 • Communicate financial impacts of actuarial findings to pricing specialists, acquisition personnel, and senior Government decision-makers

🎯 Requirements

• Bachelor's degree in Finance, Economics, Mathematics, Actuarial Science, Statistics, Healthcare Administration, or a related field • 8+ years of experience in healthcare actuarial analysis, managed-care analytics, healthcare economics, rate development, or related work • 6+ years of experience developing, reviewing, or validating managed healthcare cost and utilization projections • Experience with utilization forecasting, medical trend, unit cost, provider reimbursement, risk adjustment, rate development, claims completion/IBNR, or experience studies • 6+ years of experience independently evaluating actuarial assumptions and complex models • Advanced Excel • Strong technical-writing skills • Ability to communicate actuarial findings and financial implications to non-actuarial stakeholders under compressed deadlines • Currently authorized to work in the United States on a full-time basis • Ability to obtain a Public Trust Security Clearance • Preferred: experience supporting federal or state healthcare procurements, proposal evaluations, rate reviews, or contract negotiations • Preferred: experience with Medicare, Medicaid, TRICARE, VA Community Care, Federal Employees Health Benefits, commercial managed care, or comparable large healthcare programs • Preferred: experience evaluating health-plan, third-party administrator, provider-network, medical, dental, or pharmacy proposals • Preferred: knowledge of applicable Actuarial Standards of Practice • Preferred: experience using SQL, SAS, R, Python, Power Query, Power BI, or other actuarial and analytical tools • Preferred: experience preparing formal actuarial reports, proposal-evaluation findings, rate certifications, actuarial opinions, or negotiation-support analyses

🏖️ Benefits

• 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