At UPMC, we are committed to keeping our communities safe and healthy as the COVID-19 pandemic unfolds.

Our recruiters will continue to fill positions throughout this time, but interviews and other processes may be modified to protect the safety of our candidates and employees. Thank you for your patience.

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

Search Our Jobs

   Current UPMC employees must apply in HR Direct

Manager, Actuarial Services- Department of Health Economics (Remote, US)

Description

Shape the world of health care by joining UPMC! As a leader in the industry, we are committed to enhancing the lives of all who are a part of our community. Without our employees, we would not be able to innovate health care for our patients and health plan members. From hospitals to our corporate office, all UPMC employees impact our mission of creating life-changing medicine. To continue our tradition of excellence, we are in search of an Actuary Manager to join this community as well.

The Department of Health Economics is seeking an Actuary Manager! This position would have exposure to extremely high-level analytics and would be a work-from-home position anywhere within the continental US with the expectation to travel into Pittsburgh (2-3 times a year) for meetings/conferences. 

The Actuary Manager brings together a diverse set of senior skills and experience, including advanced analytics methods, broad-based business and health economics acumen, and insights derived from consulting experience relating to national approaches to business strategies in the healthcare reform era. The Actuary Manager, Health Economics reports to the Vice President, Health Economics, and serves as a critical member of the Health Economics leadership team, which continuously transforms the decision support needs of Insurance Services Division executive leadership into actionable and impactful analytics efforts. Not only is UPMC Health Plan an industry leader, but this selected individual would be able to work closely with UPMC Enterprises and UPMC International, two other rock-star divisions of UPMC. 

Experience in the following is a strong preference: FSA with experience in value-based reimbursement, population health, segmentation/ stratification, & claims development 

Learn more about the award-winning UPMC Health Plan here!


Responsibilities:

  • Provide pricing tools to enable Underwriting personnel to produce accurate price quotes on request from Sales and Marketing staff in a timely basis, along with appropriate supportive documents that may be needed to facilitate sales.
  • Work 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.
  • Ensure that departmental work products meet the highest standards of quality.
  • Supervise Actuarial and Underwriting department personnel to ensure that departmental objectives and goals are achieved in a timely manner.
  • Work closely with the underwriting department.
  • Ascertain and comply with filing and actuarial requirements for participation in government-sponsored health plans as appropriate.
  • Provide Health Plan senior management with regular and ad hoc reports which communicate current and future near and long-term projections of financial performance of the various product lines in order to facilitate corporate decisions and the development of corporate strategies and goals.
  • 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.
  • Provide appropriate UPMC management with actuarial valuations of the impact of any proposed benefit changes or new product designs on an as-needed basis.
  • Provide reports for the purpose of evaluating and advising Health Plan management on the financial impact of proposed provider agreements or changes to existing agreements on an as-needed basis.
  • Work with the Health Plan-appointed actuary to ensure satisfactory filings of annual Statements of Actuarial Opinion and associated memorandum.
  • Work with Federal, State and regulatory auditors to resolve discrepancies.
  • 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.
  • Advise Health Plan senior management on the financial impact of any special pricing or contract arrangements which may affect Health Plan financial profitability.
  • Direct the development and assessment of underwriting methods and tools in order to enhance the ability of underwriting staff to accurately identify and quantify risk to produce price quotes which appropriately match premium to risk.

 

Qualifications

  • Bachelor's degree in mathematics, statistics, actuarial science, economics, or related field required.
  • Advanced degree preferred-- FSA
  • Experience in the following is a strong preference: Value-based reimbursement, population health, segmentation/ stratification, claims development etc. 
  • Six and a half (6.5) years of experience in progressively more responsible actuarial work in health insurance/managed care or equivalent training/education.
  • Experience with commercial and government health programs is preferred.
  • 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.
  • Management experience preferred.


Licensure, Certifications, and Clearances:
Licensure/Certification: ASA or FSA certification by Society of Actuaries required.

Membership in the American Academy of Actuaries is required.


UPMC is an Equal Opportunity Employer/Disability/Veteran

#LI-ISD

Total Rewards

More than just competitive pay and benefits, UPMC’s Total Rewards package cares for you in all areas of life — because we believe that you’re at your best when receiving the support you need: professional, personal, financial, and more.

Our Values

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