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Program Analyst - Actuary - IoT BigData Jobs

Program Analyst – Actuar...

NCState State of North Carolina

This position is exempt from the provisions of the State Human Resources Act (G.S. 126) except for the provisions of Articles 6 and 7 per HB 372 Section 20.

The North Carolina (N.C.) Department of Health and Human Services (DHHS), in collaboration with our partners, protects the health and safety of all North Carolinians and provides essential human services. North Carolina's DHHS is one of the largest, most complex agencies in the state and has approximately 18,000 employees. It is responsible for providing human service needs for special populations including individuals who have physical disabilities, auditory and visual impairments, developmental disabilities, and mental health issues as well as helping poor North Carolinians achieve economic independence. In September 2015, Session Law 2015-245 (House Bill 372) was enacted, creating the Division of Health Benefits (DHB) within DHHS. DHB is responsible for leading the transformation of the NC Medicaid Program through a Section 1115 Waiver. DHB intends to improve the healthcare of North Carolinians by moving from a volume-based to a capitated value-based health care system, improving the beneficiary experience of care, improving the health of Medicaid recipients, and reducing the cost of health care.

Primary Purpose of the Position :

The position will work cooperatively with DHB leadership team to carry out the division's mission, goals and objectives while championing statewide core values; Accountability, Customer Service, Diversity & Inclusion, Safety & Health and Teamwork & Collaboration. The purpose of this position is to provide highly technical actuarial services at the Department level in support of pricing, rate setting, financial budgeting, forecasting, data validation and analytics, clinical policy analysis and planning. Another component of this position is to be fully integrated into the design, development and implementation of the 1115 Waiver and other components of Medicaid Reform to include managing and coordinating processes, consultants, stakeholders, contractors etc. This position may work closely with the Governor's Office, the DHHS Secretary's Office, staff from other DHHS agencies, DMA staff, DHB staff, members of the General Assembly, federal officials from the Health Care Administrations, staff from national and state advocacy organizations, and representatives from Medicaid recipients, hospitals, nursing facilities, and other providers of medical care.

50% Rate Development and Execution

Support Rate setting, financial budgeting and forecasting, clinical policy, analytics and planning; Aid in the design of benefit structures, reimbursement standards, and the effects of proposed practices and standards on the cost of healthcare

  • Support management and oversight of actuarial contractor(s), including validating work plans and defining and reviewing deliverables
  • Provide support for claim data aggregation and analysis
  • Establish and validate assumptions and methodologies for estimates; actuarial review of rate methodologies and forecasts
  • Assist the agency with the development of trends, including recommendations for changes reflecting current treatment outcomes
  • Support for actuarial reviews of rates and validation of data
  • Communicating and reviewing results to multiple audiences and levels of management in a meaningful and understandable way
  • Developing expected utilization of new services and outcomes of changes in clinical policy
  • Preparing, developing and creating models that integrate actual, expected and forecasted data and factors
  • Develop or review adjustments for programmatic changes
  • Recommend network-specific risk adjustments for the rates

40% Design, Development and Implementation of Medicaid Reform

Support processes, consultants, stakeholders, contractors etc. relative to the 1115 Medicaid Transformation and Innovations Waiver and other Medicaid Reform implementation activities

  • Support management of the primary waiver/program design and development contractor(s) to include input into defining and reviewing deliverables
  • Work with various internal stakeholder groups to ensure adequate input into the process
  • Support other work streams, including project management, budget and technology

10% Other related duties as assigned

Knowledge, Skills and Abilities / Competencies

  • Documented ability to work collaboratively with management
  • Comprehensive knowledge of health insurance rate setting, health care data analytics, current developments and trends
  • Ability to interpret complex data, data sets and other information and to identify and communicate trends and probable outcomes
  • Excellent critical thinking, problem solving and project management skills
  • Strong interpersonal, organization and detail orientation skills
  • Proficient in MS Office including Word and Excel
  • Proficient in SAS, SQL or other analytical tools
  • Proven ability to apply statistics and participate as a contributing team member

Minimum Education and Experience Requirements
Four-year degree in mathematics, business, or closely related field from an accredited institution and completion of one of the professional actuary society exams. Three (3) years of actuarial or health care data analytics and rate setting experience in either a Medicaid, consulting and/or Health Insurance setting

Management Preference:

  • Candidate with advanced working experience in an actuarial capacity
  • Associate of the Society of Actuary preferred
  • Prefer five (5) – ten (10) years' actuarial or health care data analytics and rate setting experience in either a Medicaid, consulting and/or Health Insurance setting

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