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Possessing working experience in Payer or Provider operations (domain areas such as Medical Management, Population Health Management, Utilization Management, Provider Network Management, Value-Based Contracting, Provider Relations, Quality Improvement, Informatics, ACO operations, etc.
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Possessing working experience with Population Health Management technologies and approaches (e.g., high-risk user stratification tools, cost/quality/utilization trend analysis, provider performance tools.
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Proficiency with data visualization tools such as PowerBI, Tableau, or Sigma Familiarity with Snowflake or other cloud-based query applications Actuarial/statistical based analysis Experience with extraction, transformation, and loading disparate healthcare data sources Demonstrated ability to work on multiple projects simultaneously while leading a team Understand current issues in health care financing, delivery, policy, and regulations.
ExpandApply NowActive JobUpdated 9 days ago - UpvoteDownvoteShare Job
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Support the Government Programs & Provider Risk Actuarial Models team's development of actuarial models to be used for medical expense and trend analysis and forecasting, provider risk contract evaluation, and ACO REACH / MSSP performance evaluation.
Work from homeExpandUpdated 7 days ago - UpvoteDownvoteShare Job
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Perform ad-hoc data analysis using Excel, SAS, SQL (Databricks). Working knowledge of the CMMI Direct Contracting or Accountable Care Organization (ACO) program(s) Lead quarterly medical expense analysis, IBNR / Reserving (monthly), and forecasting process, with assistance from actuarial analyst staff.
Work from homeExpandUpdated 8 days ago - UpvoteDownvoteShare Job
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The Senior Actuarial Consultant will lead actuarial workflows in support of ACO REACH & MSSP performance evaluation and forecasting. 2+ years working with a CMMI ACO Model (of any kind) is strongly preferred.
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Lead provider risk contract evaluations and ACO REACH / MSSP performance evaluations, interfacing with internal NeueHealth team and external consulting actuaries. Lead the evaluation of financial implications of provider participation in networks for ACO REACH / MSSP opportunities.
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Document and present summary review memos in support of the quarterly medical expense analysis and forecasting process in preparation for, and as follow up to, collaboration with various owned clinics and NeueHealth SMEs and leaders.
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Produce, understand, and interpret internal and external analysis and reports; provide effective technical and non-technical support to internal and external stakeholders. Lead the development of contract analysis assumptions to inform contract evaluation decisions and plan benefit development and provide guidance to NeueHealth and the owned clinics teams.
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In addition, this role leads value-based contracting (VBC) workflows to include evaluation and forecasting of full and partial risk arrangements between NeueHealth affiliated providers and payors from multiple LOBs (Commercial, Medicare Advantage, Medicaid, etc.
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Proficient in Microsoft Excel (VBA, advanced data visualization, etc.) Experience with forecasting, modeling, SQL (Databricks experience is a plus) Bachelor's degree required in Math, Statistics, Economics, Actuarial Science, or a related field.
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2+ years working with individual/small group ACA rate filings or Medicare Advantage bids is preferred. 4+ years of actuarial experience with 5+ years working within healthcare. Understanding of company practices related to management of member populations for purposes of estimating risk.
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Additional cross-functional support role working with Line of Business, Analytics, Finance, Marketing and other areas of the company that may need data summarization, modeling framework or research help.
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Collaborate with Finance team in the development of forecasting models, projections and relevant information to inform C-Level business decisions. Actual compensation will vary based on the applicants education, experience, skills, and abilities, as well as internal equity.
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We uniquely align the interests of health consumers, providers,and payors to make high-quality healthcare accessible and affordable to all populations across the ACA Marketplace, Medicare, and Medicaid.
Work from homeExpandUpdated 8 days ago
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