COVID-19 Vaccination Information

Across UPMC, our guiding principle is to always prioritize the safety of our employees, patients, and members. UPMC believes that vaccination is important, helps protect all, and advocates that everyone who can be vaccinated should be vaccinated.

UPMC complies with all governmental requirements related to local, state, and federal COVID-19 vaccination for employment. The Jan. 13 Supreme Court of the United States decision that the Centers for Medicare & Medicaid Services federal COVID-19 vaccine mandate will move forward requires UPMC to ensure employees either get vaccinated or receive a requested medical or religious exemption.

If you are not yet vaccinated, we urge you to get a vaccine now. You can schedule your COVID-19 vaccination through UPMC or visit a non-UPMC provider or UPMC Urgent Care location.

Proof of vaccination is not required upon hire; however, employees will be responsible for ensuring post-hire compliance by getting vaccinated or requesting a medical or religious exemption.

For more information about UPMC’s response to COVID-19, please visit UPMC.com/coronavirus.

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   Current UPMC employees must apply in HR Direct

Director, Actuarial Services (Pharmacy) - Remote

Description

We have an exciting opportunity for a full-time Director of Actuarial Services to join the UPMC Health Plan leadership team.  As Director, you will lead the team analyzing Phamacy pricing and trends.  The selected candidate can work 100% remote. If this sounds like an opportunity that meets your interests, we invite you to learn more and apply today!

UPMC offers a premier benefits package, designed to care for your total well-being — physically, emotionally, and financially — paired with endless opportunities for career advancement and educational growth.  Kickstart a rewarding career with UPMC!

Responsibilities:

  • Consultant within UPMC Health System; Act as an Actuarial Consultant within the UPMC Health System and perform various activities, Including IBNR calculations, Data Analysis.
  • Ensure that the departmental work products meet the highest standards of quality.
  • Reserving: Works with the financial reporting department to develop reserve amounts for IBNR claims, active claims and premium deficiency reserves on a regular or as-needed basis.
  • Benefits and Product Development: To provide appropriate UPMC management personnel with actuarial valuations of the Impact of any proposed benefit changes or new product designs on an as-needed basis.
  • Underwriting: Works closely with the underwriting department to:Provide pricing tools to enable underwriting personnel to produce accurate price quotes on request from Sales and Marketing staff in a timely basis, together with whatever appropriate supportive documents may be needed by sales staff to facilitate sales.
  • Provider Relations/contracting: To provide reports for the purpose of evaluating and advising UPMC HP management on the financial impact of proposed provider agreements or changes to existing agreements on an as-needed basis.
  • Manage Actuarial Department: Supervise Actuarial department and various entities within UPMC Health Plan as needed to ensure department goals and objectives are met.
  • Pricing: To develop product pricing levels, factors and methods to ensure premium and revenue flow adequate to cover medical and administrative costs and profit margins for the various product lines consistent with corporate strategic goals. Also, to advise UPMC Health Plan senior management on the financial impact of any special pricing or contract arrangements which may affect health plan financial profitability.
  • Work with the UPMC HP Appointed Actuary to ensure satisfactory filings of annual Statements of Actuarial Opinion and associated memoranda.
  • Direct the development and assessment of underwriting methods and tools in order to enhance the ability of underwriting staff to accurately identity and quantify risk, and so produce price quotes which appropriately match premium to risk.
  • Supervise Actuarial department personnel to ensure that departmental objective and goals are achieved in a timely manner
  • Forecasting: To provide UPMC HP senior management with regular and ad hoc reports which communicate current and future near- and long-term projections of financial performance of the various health product lines in order to facilitate corporate decision and the development of corporate strategies and goals.
  • Compliance: Ensure that all required statutory rate filings are submitted appropriately, and that all rates, factors and methods are in compliance with applicable state and federal regulations. Ascertain and comply with filing and actuarial requirements for participation in government-sponsored health plans as appropriate.
  • Additional Business: Ability to learn new lines of business to help UPMC Health Systems to expand into different arenas such as Slop Loss Insurance or Workers Compensation.

Qualifications

  • Minimum Bachelor's degree in mathematics, statistics, actuarial science, economics or related field. Advanced degree preferred.
  • 8 plus years of experience in progressively more responsible actuarial work in health insurance/managed care or equivalent training/education.
  • Experience with both commercial and government health programs preferred, specific involvement with the new MMA regulation; in-depth understanding of health insurance market dynamics.
  • Excellent problem-solving and analytical skills.
  • Good oral and written communication skills.
  • Strong PC skills.Data retrieval skills and relational database experience.


Licensure, Certifications, and Clearances:

  • ASA or FSA certification by Society of Actuaries required.
  • Membership in the American Academy of Actuaries required.
  • Act 34

UPMC is an Equal Opportunity Employer/Disability/Veteran

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At UPMC, we’re driven by shared values that guide our work and keep us accountable to one another. Our Values of Quality & Safety, Dignity & Respect, Caring & Listening, Responsibility & Integrity, Excellence & Innovation play a vital role in creating a cohesive, positive experience for our employees, patients, health plan members, and community. Ready to join us? Apply today.

   Current UPMC employees must apply in HR Direct

Security Alert

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If you suspect you have been a victim of a fraudulent UPMC job offer, please report the attempt using this form.