Job Description
Who we are Community Health Plan of Washington is
an equal opportunity employer committed to a diverse and inclusive workforce. All qualified applicants will receive consideration for employment without regard to any actual or perceived protected characteristic or other unlawful consideration.
Our commitment is to: •Strive to apply an equity lens to all our work.
•Reduce health disparities.
•Become an anti-racist organization.
•Create an equitable work environment.
About the Role This position is responsible for working with other actuaries, analysts, and professionals across the organization on budget development, design and pricing, and ACA rate filing, along with other actuarial activities.
To be successful in this role, you: - Possess a bachelor's degree in Business Administration, Health Information Management, Healthcare Administration, Analytics, or other relevant academic field, or an equivalent combination of education and highly relevant experience preferred.
- Are currently an Associate or Fellow of the Society of Actuaries in good standing. Membership in the American Academy of Actuaries is preferred.
- Have a minimum of five (5) years' experience working in an actuarial capacity for a health insurer or healthcare consulting organization.
- Have experience with Affordable Care Act (ACA) rate development and rate filings.
- Have experience with health actuarial issues and projects with increasing responsibility over time, particularly issues related to managed care cost projection.
Essential functions and Roles and Responsibilities: - Builds and applies the appropriate analytical tools and models to the data by performing actuarial, statistical, and predictive analysis for reserves, pricing, annual revenue and claim projections.
- Develops, analyzes, and implements risk contracts and prepares management reports supporting new capitation and related initiatives.
- Builds actuarial, financial, valuation, and forecasting models for all lines of business.
- Prepares and files reports/exhibits to the Centers for Medicare and Medicaid Services (CMS), Health Care Authority (HCA), Office of the Insurance Commissioner (OIC), and other entities.
- Serves as primary point of contact and CHPW representative to CMS, HCA and/or OIC.
- Performs ad hoc drilldowns into the data and fulfills ad hoc requests from internal and external customers.
- Leads projects/initiatives owned by Healthcare Economics that span departments and holds accountability for project/initiative success.
- Conducts complex quantitative analyses using tools such as SQL, Excel.
- Shares strategic insights by applying expertise and specialized actuarial training in all aspects of work.
- Exhibits initiative in exploring and discovering opportunities to improve corporate performance through data analysis.
- Presents analyses/reports in clear and useful format to management and colleagues in other departments.
- Provides mentorship and peer review for other actuarial team members.
- Other duties as assigned. Essential functions listed are not necessarily exhaustive and may be revised by the employer, at its sole discretion.
Knowledge, Skills, and Abilities: - Analytical skills and the ability to interpret, evaluate and formulate action plans based upon data.
- Knowledge of medical billing and claims/capitation data sets, such as, DRG, CPT, ICD-9/ICD-10.
- Familiarity with external datasets to use for benchmarking.
- Skilled in using Microsoft Office applications, especially Word and Excel.
- Effective verbal and written communication skills, and the ability to present analysis and reports to a variety of audiences.
- Ability to organize, prioritize, and manage work to completion.
- Ability to work independently and in a team environment.
Note: If you think you do not qualify, please reconsider. Studies have shown that women and people of color are less likely to apply to jobs unless they feel they meet every qualification. However, everyone brings different strengths to the table for a job, and people can be successful in a role in a variety of ways. If you are excited about this job but your experience doesn't perfectly check every box in the job description, we encourage you to apply anyway.
As part of our hiring process, the following criteria must be met: - Complete and successfully pass a criminal background check.
Criminal History: includes review of criminal convictions and probation. CHPW does not automatically or categorically exclude persons with a criminal background from employment. The applicant's criminal history will be reviewed on a case-by-case basis considering the risk to the business, members, and/employees.
- Has not been sanctioned or excluded from participation in federal or state healthcare programs by a federal or state law enforcement, regulatory, or licensing agency.
- Vaccination requirement (CHPW offers a process for medical or religious exemptions)
- Candidates whose disabilities make them unable to meet these requirements are considered fully qualified if they can perform the essential functions of the job with reasonable accommodation.
Compensation and Benefits: The position is FLSA Exempt and is not eligible for overtime and has a 10% annual incentive target based on company, department, and individual performance goals. The base pay actually offered will take into account internal equity and also may vary depending on the candidate's job-related knowledge, skills, and experience among other factors.
CHPW offers the following benefits for Full and Part-time employees and their dependents:
- Medical, Prescription, Dental, and Vision
- Telehealth app
- Flexible Spending Accounts, Health Savings Accounts
- Basic Life AD&D, Short and Long-Term Disability
- Voluntary Life, Critical Care, and Long-Term Care Insurance
- 401(k) Retirement and generous employer match
- Employee Assistance Program and Mental Fitness app
- Financial Coaching, Identity Theft Protection
- Time off including PTO accrual starting at 17 days per year
- 40 hours Community Service volunteer time
- 10 standard holidays, 2 floating holidays
- Compassion time off, jury duty
Sensory/Physical/Mental Requirements: Sensory* :
- Speaking, hearing, near vision, far vision, depth perception, peripheral vision, touch, smell, and balance.
Physical*: - Extended periods of sitting, computer use, talking and possibly standing
- Simple grasp, firm grasp, fine manipulation, pinch, finger dexterity, supination/pronation, wrist flexion
- Frequent torso/back static position; occasional stooping, bending, and twisting.
Mental :
- Frequent decision-making. Ability to gather and assess data, determine appropriate actions, apply protocols and knowledge to unique situations, problem-solve and provide consultation.
Work Environment: Office environment Employees who frequently work in front of computer monitors are at risk for environmental exposure to low-grade radiation.
Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities
The contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor's legal duty to furnish information. 41 CFR 60-1.35(c)
Job Tags
Holiday work, Full time, Temporary work, Part time, For contractors, Trial period, Flexible hours,