Company Overview Commonwealth Care Alliance is a rapidly growing nonprofit organization providing integrated health care and social support services to people with complex medical needs. Our patients are seniors and persons with disabilities covered under Medicaid or both Medicaid and Medicare. Our innovative care model is nationally recognized for its effectiveness in improving health outcomes for these vulnerable populations.
Our unique care model is empowering for our employees as well as our members. Whether you are a clinical or administrative professional, all of us at Commonwealth Care Alliance receive the satisfaction of knowing our work truly makes a difference. We enjoy a company culture of passionate advocacy in a supportive work environment with opportunities for growth and learning, competitive salaries, and a generous and comprehensive benefit package.Position Overview Position Summary
This position will be a member of one of the three functional areas of the Actuarial Services department, supporting Financial Reporting, Trend Analytics, or Provider Analytics. This position will be responsible for extracting and summarizing data from various sources including our data warehouse and research resources. Additionally, this position will create first draft of analytic models that will be guided by and reviewed by more senior staff. Key Responsibilities
Knowledge, Skills & Abilities
- Lead analysis and monitoring of provider contracts including administrative services only, full-risk and shared risk arrangements.
- Lead analysis and monitoring of CMS and MassHealth fee schedule changes.
- Lead analysis of impact of benefit changes.
- Lead work with Clinical to quantify the financial impact of changes in clinical approach, provider supply, induced demand and other factors both prospectively and retrospectively.
- Utilize and evaluate internal and external data sources to better understand market drivers and cost trends.
- Support rate discussions with Medicaid agency by providing an understanding of adequacy of rates for individual rate cells and at the product level; Identify factors that contribute to or may contribute to rate inadequacy.
- Development of budget for claims expenses and revenues; Requires working collaboratively with various individuals across the organization to understand impact of anticipated changes to operations as well as an understanding of changes in external environment.
- Monitoring of actual experience compared to budget with explanations for drivers of variance.
- ASA or near-ASA.
- 3-8 years direct experience.
- Strong knowledge of care management and healthcare industry practices.
- Strong actuarial, analytical and problem-solving skills.
- Ability to work under pressure and tight deadlines.
- Strong interpersonal and communication (verbal & written) skills.
- Ability to communicate business and technical information to people of various backgrounds.
- Distinguishes true sense of urgency.
- Ability to communicate directly and build trust with senior leaders essential.
- Initiative, work ethic, ambition, and an appetite for challenging and often unstructured assignments.
- Ability to be flexible, accommodating shifting priorities and demands, and reacting quickly to developing issues.
- Proactive and collaborative.
ALL APPLICANTS SHOULD SUBMIT A COVER LETTER WITH APPLICATION. Commonwealth Care Alliance is an equal opportunity employer. Applicants are considered for positions without regard to veteran status, uniformed service member status, race, color, religion, sex, national origin, age, physical or mental disability, genetic information or any other category protected by applicable federal, state or local laws