Job Description

Community Health Choice, Inc. (Community) is a non-profit managed care organization (MCO), licensed by the Texas Department of Insurance. Through its network of more than 10,000 providers and 94 hospitals, Community serves over 400,000 Members with the following programs:

* Medicaid State of Texas Access Reform (STAR) program for low-income children and pregnant women

* Children’s Health Insurance Program (CHIP) for the children of low-income parents, which includes CHIP Perinatal benefits for unborn children of pregnant women who do not qualify for Medicaid STAR

* Health Insurance Marketplace Plans that offer individual health coverage that includes preventive care, emergency services, prescription drugs, and hospitalization available to all, regardless of pre-existing conditions.

* Community Health Choice (HMO D-SNP), a Medicare Advantage Dual Special Needs plan for people with both Medicare and Medicaid that combines Medicare Part A and Part B benefits, Medicare Part D prescription drug coverage, and Medicaid benefits with additional health benefits like dental, vision, transportation, and more.

Improving Members' experiences is at the heart of every Community position. We strive every day to make sure that our Members have access to the high-quality health care they need and deserve.

Community is accredited by URAC for its health plan operations. We offer care management programs for asthma, diabetes, and high-risk pregnancy. An affiliate of the Harris Health System (Harris Health), Community is financially self-sufficient and receives no financial support from Harris Health or from Harris County taxpayers.

Skills / Requirements

JOB SUMMARY

This position monitors claims trends and investigates aberrations, tracks member risk scores to support risk adjustment analysis, and on-going analysis and monitoring of utilization targets. The Actuarial Senior Specialist assists in actuarial filings such as the Statement of Actuarial Opinion and ACA Marketplace rate filings. The Actuarial Senior Specialist helps to coordinate between external consultants and internal staff on annual Medicare Advantage rate filings and assess HHSC's development of the annual Medicaid rates. The Actuarial Senior Specialist supports the annual budget process and reviews work papers of other Finance staff as needed. The Actuarial Senior Specialist will also provide ad hoc assistance to senior level management as needed.

 

JOB SPECIFICATIONS AND CORE COMPETENCIES

  • Preparation of the monthly claim triangles and enrollment data to support monthly IBNP reserve estimates for all lines of business.
  • Monitoring claims trends by service category/provider and investigating any aberrations.
  • Tracking member risk scores throughout the year to assist with Risk Adjustment analysis for both ACA and Medicare Advantage lines of business.
  • Assist in the preparation of the annual Statement of Actuarial Opinion and Actuarial Memorandum.
  • Assist in the preparation of annual ACA Marketplace rate filings.
  • Coordinate between external consultants and internal staff on annual Medicare Advantage rate filings.
  • Review and assess HHSC's development of annual Medicaid rates.
  • Support annual budget process.
  • Track and report on budgeted utilization targets.
  • Review work papers of other Finance staff as needed and provide feedback.
  • Actively contributes to achievement of departmental goals, including specific departmental process improvement plans.


QUALIFICATIONS:
Education/Specialized Training/Licensure:

  • Bachelor's degree in Actuarial Science, Mathematics, Economics, or related.
  • 3 or more Society of Actuaries Exams passed required.


Work Experience (Years and Area):

  • 3 years experience in health insurance industry with proficiency in Excel and computer coding (SQL/SAS) experience.

Management Experience (Years and Area):

  • Demonstrated ability to provide guidance and support to entry level analyst roles.


Software Proficiencies:

  • Microsoft Excel and Microsoft SQL Server

NOTE: THIS IS A REMOTE OPPORTUNITY FOR TEXAS RESIDENTS ONLY! 

Application Instructions

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