Senior Financial Actuary
Mercyhealth · MercyCare Building, Janesville, Wisconsin, United States
OVERVIEW
The Senior Financial Actuary is responsible for performing actuarial analyses related to health insurance financial reporting, claim and premium reserving, financial data reconciliation and forecasting. This position works closely with Actuarial, Finance, Claims, Underwriting, IT/Reporting and other business areas to ensure the accuracy, completeness, and timeliness of actuarial information used for financial reporting, reserving and business decision-making. The position requires strong business, analytical and technical skills, attention to detail, and the ability to work with complex health insurance financial and claims data. The Senior Financial Actuary is expected to independently perform assigned analyses and contribute to the development and improvement of actuarial processes, models, controls, and reporting. The Senior Financial Actuary will advise on strengths and weaknesses by line of business along with potential risks associated with each.
Schedule: 32 hours per week
Shift: Monday to Friday Day Shifts
ESSENTIAL DUTIES AND RESPONSIBILITIES
Financial Data Retrieval and Reconciliation
- Extracts information from the data warehouse and other data sources with an emphasis on efficiency
- Reconciles actuarial data and calculations to the general ledger, financial statements, claims systems, premium systems, membership systems, risk adjustment data, and other source systems. Maintains reconciliation data and documentation.
- Performs data validation and reasonableness checks before information is used for reserving or financial reporting
- Investigates and resolves any significant financial data differences discovered
- Assists in improving data flows, reconciliation processes, and reporting automation
- Supports internal and external financial and actuarial audits
- Supports the periodic reconciliation of MercyCare Planalytics reports
- Other duties as assigned
Financial Reserving
- Prepares and analyzes monthly, quarterly, and annual health insurance claim reserves, including incurred but not reported (IBNR) and other unpaid claim liabilities, using appropriate actuarial methodologies and assumptions. Prepares reserve estimates for different lines of business and different markets as appropriate.
- Prepares premium deficiency, risk adjustment, reinsurance, and other actuarial liabilities or financial estimates as applicable
- Analyzes reserve adequacy and identifies emerging claim trends or other factors that may affect future financial results
- Performs actual-to-expected analyses and explains changes in reserve estimates from prior periods
- Performs annual maintenance of risk adjustment scoring algorithm and monthly updates of MercyCare risk scores to support reserving and risk adjustment analyses
- Advises management on significant changes in reserve estimates and the financial implications of emerging trends
- Documents reserving methodologies, assumptions, calculations, and conclusions
Financial Reporting
- Provides claim reserve, premium, membership, risk adjustment, and other actuarial estimates to Finance within established reporting deadlines
- Works with Finance to complete required quarterly Medicaid financial reporting
- Assists with Medical Loss Ratio (MLR) calculations and related analyses, as applicable
- Prepares financial reporting exhibits and management reports and communicates key drivers of financial results
- Supports financial reporting related to premiums, claims, medical expenses, administrative expenses, risk adjustment, reinsurance, and other health insurance financial items
- Leads the actuarial portion of the year-end financial close, working closely with the outside actuary on the Statement of Actuarial Opinion
Forecasting & Financial Analysis
- Develops forecasts of claims, premiums, membership, medical expenses, and other health insurance financial results
- Performs variance analyses and explains significant differences between actual and expected results
- Supports annual budgeting and financial planning processes
- Develops financial scenarios and sensitivity analyses to evaluate potential changes in claims trends, membership, premiums, reimbursement, and other financial assumptions
- Provides actuarial analysis to support management decisions and business planning
Risk Adjustment and Reinsurance
- Supports financial analysis related to Affordable Care Act (ACA) risk adjustment, including risk adjustment receivables, payables, estimates, and changes in expected results as applicable to the company’s business
- Directs the Claims Department in the prioritization of pended claim processing during Q1 of each calendar year for risk adjustment optimization
- Creates actuarial analyses of stop-loss, reinsurance, or other risk-transfer arrangements
- Analyzes the financial impact of reinsurance recoveries, attachment points, exclusions, and other contractual provisions as applicable
- Develops monthly all relevant stop loss reserves for MercyCare stop loss
- Prepares the monthly commercial reinsurance notification and filing process
- Leads the annual reinsurance renewal process, providing data and analyzing quotes
Confidentiality, Privacy, Regulatory Compliance & Company Assets
- Protects Protected Health Information (PHI), personally identifiable information (PII), confidential member information, and other sensitive company information in accordance with HIPAA and applicable privacy and security requirements
- Maintains confidentiality of proprietary actuarial, financial, business, member, provider, and employee information
- Safeguards company assets, including financial information, computer equipment, systems, data, intellectual property, and other company resources
- Uses company systems, data, and other resources responsibly and in accordance with company policies
- Completes required privacy, security, compliance, and other company training
- Assists with regulatory filings and supporting actuarial documentation as assigned
- Identifies potential control weaknesses, data integrity issues, or financial risks and appropriately escalates them to management
- Supports compliance with applicable actuarial standards, insurance regulations, accounting requirements, and company policies
EDUCATION AND/OR EXPERIENCE
Minimum Required:
- Bachelor’s degree in Actuarial Science, Mathematics or Statistics, or a related quantitative field
- Minimum 10 years of relevant actuarial experience, preferably in a health insurance environment
- Experience working with medical and drug claims, premiums, membership, and related financial data
- Demonstrated experience performing actuarial or financial analyses and reconciling data from multiple sources
Preferred:
- Experience with health insurance financial reserving
- Knowledge of statutory or Generally Accepted Accounting Principles (GAAP) financial reporting
- Experience with ACA, Medicare Advantage, Medicaid, or other health insurance programs
- Experience with risk adjustment, MLR, reinsurance and stop-loss
- Experience with Structured Query Language (SQL), Python, R, Power BI, Power Query, Visual Basic, Excel pivot tables or other analytical/data tools
- A background supporting actuarial and financial audits
CERTIFICATION/LICENSURE
Minimum Required:
Fellowship in the Society of Actuaries
OTHER SKILLS AND ABILITIES
Technical Skills
- List key technical or job-specific skills required (e.g., proficiency with electronic health records, specialized equipment, software applications).
- Include any required training or ongoing education.
- Strong analytical, problem-solving, and critical-thinking skills
- Strong attention to detail and ability to identify data, calculation, and financial reporting discrepancies
- Advanced proficiency with Microsoft Excel and other analytical tools
- Ability to manage mul