naviHealth, Inc. Healthcare Actuarial Specialist in Brentwood, Tennessee
naviHealth is seeking an experienced actuarial specialist, to support all actuarial needs with respect to a portfolio of client relationships. While this Team is highly collaborative, this is an analytical, individual-contributor role requiring rich healthcare experience, critical thinking skills, independence, strategic mindset, attention to detail, and an ability to multi-task in a fast-paced non-traditional actuarial environment.
Research, analyze, present results, and recommend intelligent solutions to solve problems and address business challenges by applying a knowledge of data analysis, critical-thinking skills, and healthcare experience/expertise.
Structure analytical results in an organized, visual manner to tell a meaningful, actionable story.
Write SQL queries, build excel models, and apply varying actuarial techniques to solve specific business problems.
Develop and apply predictive algorithms for organizational strategy and targeting.
Develop models for projecting and evaluating healthcare cost trend.
Maintain and expand upon current statistical models used to measure business results.
Perform data quality checking and usability analysis to identify anomalies which need to be addressed prior to delivery of analytic results.
Develop, implement and revise detailed claims analysis. Build and apply completion factors for IBNR estimates.
Monthly revenue projections and annual client Use actuarial judgement to adjust these processes where necessary.
Establish trusting professional relationships with internal senior business customers. Maintain alignment of expectations and priorities in autonomous fashion.
Perform other duties and responsibilities as required, assigned, or requested.
2-3 years of experience or proven ability working as an actuarial analyst in the health industry, preferably Medicare Advantage.
Minimum of a Bachelor’s degree in Actuarial Science, Mathematics, or Statistics.
2+ actuarial exams preferred.
Expertise in MS Excel and reasonable experience with Structured Query Language (SQL)
Ability to build SQL and excel based actuarial models.
Ability to effectively explain and audit model results.
Experience with predictive modeling and statistical analysis.
Proven experience working with Medicare paid claims data sets. Other applicable data sets include standard CMS files such as the MMR, MOR, and LDS.
Experience in data mining and data transformation/manipulation.
Advanced analytic skills with the ability to analyze and interpret data through complex analysis.
Ability to tell a succinct, meaningful, and actionable story with data using visualization and other techniques.
Strong communication skills (both verbal and written).
Strong time management skills.
Can complete project deliverables, meet deadlines, and ensure compliance with quality procedures.
Organizational expertise and flexibility.
Client (internal and external) focused and results oriented.
naviHealth is improving the healthcare experience for seniors to live more fulfilling lives. For nearly a decade, naviHealth has been a trusted partner for the nation’s top health plans, health systems, and at-risk physician groups navigating the shift from volume to value. Powered by a predictive technology and decision support platform that provides clinicians and care teams with evidence-based protocols, naviHealth’s high-touch, proven care model fully supports patients from pre-acute through to the home. With naviHealth, patients can enjoy more days at home, and healthcare providers and health plans can significantly reduce costs specific to unnecessary care and readmissions. For more information about naviHealth, visit navihealth.com.
Improving the healthcare experience for seniors to live a more fulfilling life
Rooted in respect
Guided by purpose
Devoted to service
Energized by impact
The above statements are intended to describe the general nature and level of work performed by colleagues assigned to this job. It is not designed to contain or be interpreted as a comprehensive list of all duties, responsibilities, and qualifications. naviHealth reserves the right to amend and change responsibilities to meet business and organizational needs as necessary.
naviHealth is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, protected veteran status, or any other protected status under applicable laws and will not be discriminated against on the basis of disability.
External Job Posting Title: Healthcare Actuarial Specialist
Requisition ID: 2021-6599
Street: 210 Westwood Place
Location Type: Field / Office / Virtual: Corp Office