Horizon BCBSNJ employees must live in New Jersey, New York, Pennsylvania, Connecticut or Delaware
Job Summary:
This is an Actuary position within the Risk Adjustment department. This position will require deep and significant analysis, and data-mining, to ensure that accurate claims/encounter data. Develop mathematical modeling techniques and statistical concepts to determine probability and assess risks. This position will need to work closely with a multitude of departments, being able to rapidly understand and navigate new situations and to be able to create solutions on the go.Perform and support trend analysisPerform risk adjustment analytical studies that involve manipulations of large amounts of data.Identify patterns and trends in diagnostic coding practice in conjunction with risk score measurement. Conduct gap analysis and data collection and validation. Stay abreast of government regulations as related to the 3R’s.Quantify and project risk scores and revenue for the Medicare line of businessServe as subject matter expert for Medicare regulations, procedures, and requirementsConduct complex actuarial analyses to assess risk scoresCreate data-driven solutions for capturing risk and improving quality of care for our membersPerform vendor return on investment analyses to determine ongoing benefit and decision supportDevelop and execute work plans that may involve collaboration with more than one teamIdentify systems and operational problems, and recommend solutions and changes to streamline procedures for more effective reportingPerform root cause analysisPresent and explain results to executive leadershipOther responsibilities as assignedAnalyze enrollment and claims data for patterns and trends to identify opportunity to improve documentation and coding.Monthly P&L financial reconciliations and frequent liaisons with the Finance teamPresent reports, explaining their implications to managers and directors, and advising on risk limitationCommunicating with internal clients and carrying out relationship with financial directors and stakeholdersAd-hoc modeling and projects.Education/Experience:
Requires a Bachelor’s degree, preferably within Mathematics, Statistics, Actuarial Sciences or a related field from an accredited college or university2 years of actuarial and/or statistics experienceExperience in the health insurance industry preferredAssociate, Society of Actuaries (ASA) preferred
Knowledge:
Skills and Abilities:
Requires good oral and written communication skillsRequires strong analytical thinkingRequires strong mathematical skill and statistical analysis abilitiesRequires good judgment and problem solving skills
Salary Range:
$76,800 - $102,795This compensation range is specific to the job level and takes into account the wide range of factors that are considered in making compensation decisions, including but not limited to: education, experience, licensure, certifications, geographic location, and internal equity. This range has been created in good faith based on information known to Horizon at the time of posting. Compensation decisions are dependent on the circumstances of each case. Horizon also provides a comprehensive compensation and benefits package which includes:
Comprehensive health benefits (Medical/Dental/Vision)
Retirement Plans
Generous PTO
Incentive Plans
Wellness Programs
Paid Volunteer Time Off
Tuition Reimbursement
Horizon Blue Cross Blue Shield of New Jersey is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or status as an individual with a disability and any other protected class as required by federal, state or local law. Horizon will consider reasonable accommodation requests as part of the recruiting and hiring process.