AVP leading actuarial data and reporting systems at Manulife. Responsible for overseeing system changes and ensuring accuracy in reporting across multiple regions.
About the role
- Actuary analyzing Medicaid claims, forecasting trends, and building Databricks analytics datasets for Humana. Collaborating with actuarial, financial, and clinical teams.
Responsibilities
- Design and maintain Medicaid claims analytics dataset using Databricks
- Conduct in-depth analysis of healthcare claims utilizing revenue codes, CPT/HCPCS, ICD-10 diagnosis codes, DRG, etc.
- Partner with actuarial, financial, and clinical teams to align on data definitions, methodologies, and reporting
- Identify cost drivers, utilization patterns, and anomalies in Medicaid medical claims data
- Maintain dashboards to communicate key trends to stakeholders
- Ensure data integrity by developing and executing processes and controls around the flow of data
- Collaborate with stakeholders to understand business needs, troubleshoot problems, perform root cause analysis, and develop resolutions for data anomalies
- Advise executives and develop functional strategies on matters of significance
- Analyze and forecast financial, economic, and other data to inform strategic and operational decisions
- Establish metrics and provide data analyses to support business intelligence
Requirements
- Bachelor's Degree
- FSA or ASA plus relevant advanced degree, recent and relevant work experience, and/or other relevant professional designations
- MAAA
- Strong communication skills
- Experience in more than two functions (e.g., modeling, pricing, rate filing, reporting & analysis, reserving or trending)
- Experience in managing large healthcare claim datasets and conducting trend analysis
- Deep understanding of healthcare claims taxonomy (service categories, such as LTSS)
- Advanced knowledge of Databricks, SQL, or Python
- Proficient with data visualization tools such as Power BI and Tableau
- Demonstrated project management skills and ability to gather customer input and translate into business requirements
- Ability to translate complex data into actionable insights
- Ability to travel occasionally to Humana offices for training or meetings
Benefits
- Competitive benefits that support whole-person well-being
- Medical, dental and vision benefits
- 401(k) retirement savings plan
- Time off including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave
- Short-term and long-term disability
- Life insurance
- Bonus incentive plan
- Other opportunities and programs to support associate well-being
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