Manager, Actuarial Services – Tools & Models
公司：
AHI agilon health, inc.
职位发布地点：
远程 - 美国
职位名称：
精算服务经理 – 工具与模型
职位描述：
候选人必须在美国合法工作，无需雇主担保，现在或将来均如此。
精算服务经理将负责agilon的医疗保险优势（MA）和基于价值的护理人群在准备金和预测索赔中使用的核心精算模型和工具。该经理将通过直接管理和项目领导来支持精算分析师的发展。该经理将积极监控和评估数据质量，推动医疗利润模型的改进，并增强标准化报告工具，以实现市场和全国范围内的结算结果。
该经理将在年度预算流程中发挥核心作用，包括趋势研究和使用保险公司投标数据量化年度福利变化，并为福利相对性推荐趋势调整。随着CMS将ACO REACH计划过渡到ACO LEAD，该经理将协助设计和构建支持新计划的精算模型。
这是一个完全远程的职位，仅需少量出差。该职位向中央精算团队的高级总监汇报。中央团队开发和维护支撑市场团队每月结算流程的模型、工具和方法。该职位对精算团队的运作至关重要，经理将是精算和更广泛的数据解决方案组织中的关键领导者。
主要工作职责：
- 开发和维护精算模型和工具
- 积极监控和评估数据质量
- 推动医疗利润模型的改进，包括IBNR和收入摊销方法
- 每季度评估并设定全国保险公司的索赔完成系数
- 利用声明数据和/或保险公司数据流开发和维护标准化报告工具，用于结算结果
- 支持年度预算的制定，包括趋势研究和关键索赔假设
- 利用保险公司投标数据量化年度福利设计变化，并为福利相对性推荐索赔趋势调整
- 在CMS指导出现后，支持ACO LEAD计划的精算模型的设计和构建
- 与市场精算团队合作，识别全国索赔趋势的变化及前期发展驱动因素
- 共同领导项目受理，优先级排序和资源分配
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Company:
AHI agilon health, inc.
Job Posting Location:
Remote - USA
Job Title:
Manager, Actuarial Services – Tools & Models
Job Description:
Candidates must be legally authorized to work in the United States without employer sponsorship, now or in the future.
The Actuarial Manager, Tools and Models will own the core actuarial models and tools used for reserving and forecasting claims across agilon's Medicare Advantage (MA) and value-based care populations. The Manager will help support the development of actuarial analysts through direct management and project leadership. The Manager will actively monitor and assess data quality, drive enhancements to Medical Margin Models, and enhance standardized reporting tools for close results at the market and national levels.
The Manager will play a central role in the annual budget process, including trend studies and the use of payor bid data to quantify year-over-year benefit changes and recommend trend adjustments for benefit relativity. As CMS transitions the ACO REACH program to ACO LEAD, the Manager will help design and build the actuarial models supporting the new program.
This is a fully remote position, with minimal required travel. This role reports to the Sr. Director for the Central Actuarial team. The Central team develops and maintains models, tools, and methodology that underpin the monthly close process that is carried out by the Markets team. The role is critical to the operations of the Actuarial team, and the Manager will be a key leader within the Actuarial and broader Data Solutions organization.
Essential Job Functions:
- Develop and maintain actuarial models and tools
- Actively monitor and assess data quality
- Drive enhancements to Medical Margin Models, including IBNR and revenue accrual methodology
- Evaluate and set claims completion factors quarterly for national payors
- Develop and maintain standardized reporting tools for close results utilizing statements data and/or payor data feeds
- Support development of the annual budget, including trend studies and key claims assumptions
- Leverage payor bid data to quantify year-over-year benefit design changes and recommend claims trend adjustments for benefit relativity
- Support the design and build-out of actuarial models for the ACO LEAD program as CMS guidance emerges
- Collaborate with Markets Actuarial teams to identify changes in national claims trends and drivers of prior period development
- Co-lead project intake, prioritization, and progress tracking across the Markets Actuarial and Central Actuarial teams
- Manage / mentor junior actuarial analysts
- Review and update internal / external audit documentation
- Support build-out of improved actuarial team processes
Other Job Functions:
- Develop talent through coaching, mentorship, and technical review
- Collaborate with Market Finance, FP&A, Accounting, Med Econ, and others
- Identify critical issues and recommend solutions to business problems
- Contribute to team priority-setting aligned with goals established by upper management
- Exemplify the core values of agilon health
Required Qualifications:
- Minimum Experience
- 6+ years of actuarial experience (8+ years preferred)
- Demonstrated leadership via project ownership and cross-functional initiatives, mentoring analysts, serving as a trusted delegate for a senior leader, and/or prior people management
- Education/Licensure
- ASA or FSA designation
- Bachelor's degree
Knowledge, Skills, and Abilities:
- Strong model building mindset; model flow, ease of use, auditability, etc.
- Experience with reserving, forecasting, and trend development
- Excellent ability to communicate actuarial methodology, both written and verbal
- Strong understanding of Medicare Advantage; ACO REACH or MSSP background is a plus
- Understanding of MA health plan data (Claims, MMR, MAO-004, etc.)
- Proficiency with Excel and SQL
- Experience presenting actuarial/financial concepts to a non-technical audience
- Proven problem-solving skills (identification of issue, causes, solution, implementation plan)
- Proven ability to influence, grow, and motivate others
- Entrepreneurial and innovative spirit
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Location:
Remote - CO
Pay Range:
$129,700.00 - $162,100.00Salary range shown is a guideline. Individual compensation packages can vary based on factors unique to each candidate, such as skill set, experience, and qualifications.
Originally posted on Himalayas