Risk Adjustment Analyst

  • 38224
  • Health - Actuarial
  • |
  • Minnesota, United States
  • |
  • Sep 22, 2020
  • Work with the Lead Risk Adjustment and Experience team, including the actuarial team, to put together the annual benchmarks for risk transfers.
  • Work with IT team to pull data for periodic WNRAR models, including validating the data and validate errors that come back from the WNRAR checking file.
  • Engage with Risk Adjustment team to ensure the monthly models are run, support data result validation, ensure coefficient and hierarchy changes in the CMS models are incorporated in to models.
  • Perform ROI analysis on external EDGE vendor to ensure their programs and processes are returning value.
  • Perform ROI analysis on internal engagement programs that are being tested before a national rollout is performed.
  • Oversee and give guidance on priority of chart chase and value.
  • Perform data audits within the EDW to look for opportunities to reduce error rates.
  • A Bachelor’s degree in Math, Statistics, Economics, Actuarial Science, or a related field is required.
  • Four or more years of experience working with commercial ACA products is required.
  • Intermediate to expert understanding of how ACA risk adjustment works, the key drivers and most influential variables.
  • Understanding of healthcare claims data.
  • Proficient in Microsoft Excel and other Office products.
  • Experience with modeling and either SQL or SAS.
  • Intermediate to expert level knowledge of risk adjustment for ACA products.
  • Intermediate knowledge of Risk Adjustment for Medicare Advantage.
  • Understanding of company practices related to management of member populations for purposes of estimating risk.
  • Strong communication skills and ability to meet with C-Level leadership on pricing and plan related topics.
  • Associateship or greater in the Society of Actuaries or commensurate years of experience.