Network Pricing Actuary

About the role

The Network Pricing Actuary is part of the growing Network Pricing team, which partners with the national and local market Provider Contracting teams to ensure our contract negotiations, network strategy, and understanding of our network performance are informed by reliable data and modeling.

This role serves as the regional lead, responsible for work including: coordinating and presenting analyses to influence our negotiation strategy for major deals; coordinating and performing modeling to support major negotiations; facilitating market network performance management forums, bringing insights into network performance drivers and opportunities, and driving accountability; and partnering with the provider contracting and delivery system teams to develop the network strategy.

This is a leadership level role that will engage regularly with the VPs of provider contracting, the market CFOs, and the regional health plan SVP. While not having any direct reports, this role will partner closely with the network pricing analysts in the team, delegating analysis and providing guidance and coaching.

The work will require knowledge and experience of provider contracting, network strategy, and how they impact unit cost trends and product & network financial performance.

Job Summary

This individual contributor is primarily responsible for researching and determining the likelihood of financial risk to the organization, aligning actuarial documentation with financial reports and tax returns, developing and designing product line evaluations and actuarial models, and assessing, analyzing, and interpreting financial risk and opportunity.

Essential Responsibilities

• Practices self-leadership and promotes learning in others by building relationships with cross-functional stakeholders; communicating information and providing advice to drive projects forward; influencing team members within assigned unit; listening and responding to, seeking, and addressing performance feedback; adapting to competing demands and new responsibilities; providing feedback to others, including upward feedback to leadership and mentoring junior team members; creating and executing plans to capitalize on strengths and develop weaknesses; and adapting to and learning from change, difficulties, and feedback.
• Conducts or oversees business-specific projects by applying deep expertise in subject area; promoting adherence to all procedures and policies; developing work plans to meet business priorities and deadlines; determining and carrying out processes and methodologies; coordinating and delegating resources to accomplish organizational goals; partnering internally and externally to make effective business decisions; solving complex problems; escalating issues or risks as appropriate; monitoring progress and results; recognizing and capitalizing on improvement opportunities; and evaluating recommendations made by others.
• Completes actuarial documentation by reviewing and coordinating the actuarial portion of financial reports and tax returns, and responses to insurance regulations; and presenting results internally to mid-level leadership.
• Develops and designs product line evaluations by interpreting and communicating findings of analysis of product line financials, reserve, valuation, cash flow analysis; and interpreting product line performance, risk, and assumptions used in product development.
• Designs and develops actuarial research by designing complex methods to advance standards, assumptions, and the legal and regulatory environment.
• Assesses, analyzes and interprets financial risks and opportunities by using non-traditional actuarial methods and actuarial judgment when conducting actuarial analyses.
• Leads collaboration with business partners by translating complex actuarial constructs into actionable recommendations; and developing and formulating accurate actuarial and financial advice in compliance with the Actuarial Standards of Practice.
• Creates framework and assumptions for new, existing, and non-traditional actuarial models to meet business needs.