Actuary – Medical Cost Economics (Remote)

UPMC Health Plan is seeking an Actuary in its Department of Health Economics! This credentialed healthcare actuary would drive high-visibility impactful analysis and would be responsible for developing and driving medical cost improvement strategies. This includes analyzing medical cost utilization and unit cost data, identifying top trend drivers and affordability opportunities, and presenting findings to leadership. 

The Actuary will require a diverse set of skills and experience, including data and analytics expertise, broad-based business and health economics acumen, a strategic mindset, and an ability to influence and leverage cross-functional teams in a non-traditional actuarial environment. This position may also direct or supervise less experienced actuarial analysts in the performance of duties.

As an Actuary at UPMC, you will be given support for professional designations through our comprehensive student program and continuing education opportunities. Our team members can choose a work style that is best for them - this position is eligible for fully remote work or a hybrid work arrangement for candidates based in Pittsburgh, PA. 

Responsibilities:

• Lead the development of detailed actuarial and financial tools to communicate drivers of financial performance to facilitate corporate decision-making and the development of cost mitigation strategies.

• Lead and support the implementation and ongoing maintenance of the HCG Grouper software, including comprehensive data validation, testing, and quality assurance activities to ensure accurate and reliable results

• Support the enterprise-wide rollout of HCG Grouper data by creating documentation, providing user support, and facilitating knowledge transfer to business partners.

• Analyze impacts of healthcare affordability initiatives on medical cost and utilization trends.

• Apply analytical and statistical software tools to summarize large healthcare data to glean findings and actionable insights and deliver results to leadership.

• Forecast and interpret financial results, including variances from budget, to help identify medical cost improvement opportunities and potential risks.

• Analyze trends in spending and utilization using healthcare claims data.

• Develop and gain support for data-based recommendations with team members from product, clinical, network, and strategy functions.

• Guide the development of well-documented standard actuarial reports and projects.

• Present results of analyses and recommendations to management and senior leaders.

• Apply an understanding of complex actuarial concepts, methods, and applications in a variety of situations.

• Creatively leverage a wide range of datasets to inform key analyses.

• Provide direction and supervision to less experienced staff in the performance of duties. May directly manage 1 analyst.

• Build strong relationships with Actuarial, Analytics, and Finance teams across the enterprise.

• Ensure that departmental work products meet the highest standards of quality.

• Provide analytical support for ad hoc data and analyses

   

•    Bachelor's degree in mathematics, statistics, actuarial science, economics, or related field required. 
•    ASA certification by Society of Actuaries required. 
•    Experience in any of the following is a strong preference: Milliman HCG data, Power BI, claims-based experience analysis, trend analysis, population health, network and reimbursement analysis,  
•    5 years of experience in progressively more responsible actuarial work in health insurance/managed care/consulting or equivalent education. 
•    Experience with commercial and government health programs is preferred. 
•    In-depth understanding of health insurance market dynamics. 
•    Excellent problem-solving and analytical skills. 
•    Excellent oral and written communication skills. 
•    Adaptability and ability to prioritize effectively. 


Licensure, Certifications, and Clearances:
A.S.A. or F.S.A. certification by Society of Actuaries Membership in the American Academy of Actuaries
 

• Act 34

UPMC is an Equal Opportunity Employer/Disability/Veteran