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 Sr. Actuarial Analyst assists in actuarial filings such as the Statement of Actuarial Opinion and ACA Marketplace rate filings. The Sr. Actuarial Analyst 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 Sr. Actuarial Analyst supports the annual budget process and reviews work papers of other Finance staff as needed. The Sr. Actuarial Analyst will also provide ad hoc assistance to senior level management as needed.

MINIMUM QUALIFICATIONS:

1. Education/Specialized Training/Licensure:

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

2. Work Experience (Years and Area):

  • 3 years' experience in health insurance industry with proficiency in Excel and some computer coding (SQL/SAS) experience.  Prefer ability to provide guidance and support to entry level analyst roles.

3. Management Experience (Years and Area): N/A.
4. Software Operated: Microsoft Office (MS Word, MS Excel, Outlook)

SPECIAL REQUIREMENTS: (Check Applicable Areas)

1. Communication Skills:
Above Average Verbal (Heavy Public Contact)
Writing /Composing: Correspondence / Reports

2. Other Skills: Analytical, Mathematics, Research, Statistical
MS Word, MS Excel

3. Advanced Education:

Advanced Training Specialty: 3+ Society of Actuaries Exams Passed
Bachelor's Degree Major: Actuarial Science, Mathematics, or related field

4. Work Schedule: Flexible

5. Other Requirements:
Strong analytical skills, proficient with Excel, experience with SQL and SAS preferred. Experience with medical claims trends, reserving, forecasting, and pricing. Ability to communicate complex analytical results effectively. 

RESPONSIBLE TO: Director

EMPLOYEE SUPERVISED: None

Application Instructions

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