ASA Designation and/or FSA Designation

Demonstrates in-depth abilities and/or a proven record of success as a team/functional leader in the Payer and/or Provider industries including: 

• Leading functions or projects involving actuarial aspects of commercial and government programs and issues in a major consulting firm or corporate environment, emphasizing areas that include pricing, underwriting, health plan financial reporting, data analysis, and risk adjustment; 

• Interpreting and applying regulatory requirements and standards to help clients meet both compliance and strategic objectives; and, 

• Employing entrepreneurial capability to help identify and evaluate new business opportunities and continuously innovate and improve processes and products. 

Demonstrates in-depth abilities and/or a proven record of success in the following areas: 

• Analyzing clients medical claim data to understand historical trends and suggest opportunities to implement savings initiatives; 

• Writing medical cost and risk adjustment analytics using SAS to help clients identify sources of value;  

• Analyzing of a company’s financial statements finding opportunities to enhance their reporting;       

• Supporting mergers and acquisitions by evaluating a target’s financial statements and developing a quality of earnings adjustment as well as providing insight into the target’s expected future earnings potential; 

• Completing IBNR reserve analyses and assess actuarial balances as part of year-end financial audit for health and life insurance companies; 

• Researching business and industry trends to develop a point of view to leverage in assisting with proposals, considering opportunities across multiple lines of service.

Demonstrates in-depth abilities and/or a proven record of success with automation & digitization in a professional services environment including:

• Analyzing clients medical claim data to understand historical trends and suggest opportunities to implement savings initiatives; 

• Evaluating a client’s end-to-end risk adjustment process, evaluating the return on investment for each operational activity and vendor; 

• Supporting Value Based Care contracting and analytics for payers, providers, and health services organizations; 

• Developing predictive analytics to help identify gaps within a health plan’s coding procedures and optimize their revenue stream; 

• Creating a strategic roadmap with clients entering a new line of business or market, including the development of a proforma; 

• Innovating through new and existing technologies, along with experimenting with digitization solutions; 

• Working with large, complex data sets to build models and leverage data visualization tools to provide insights to clients; 

• Utilizing digitization tools to reduce hours and optimize engagements; and, 

• Knowledge of alternative fee arrangements, including the use of pricing tools, to provide a point of view on pricing strategies.