Actuarial Director, Reserves

Pediatric Associates -
Plantation, FL

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Job Details

Full-time

Qualifications

Managed care organization experience
Bachelor's degree
Health insurance knowledge
Data-driven problem-solving

Full Job Description

PRIMARY FUNCTION

The Actuarial Director, Reserves is responsible for establishing the monthly accruals related to risk-based contracts. This role will require collaboration with cross-functional teams, including accounting, FP&A, managed care, clinical, and operations, to reconcile IBNR reserves with financial statements, provide insights into variances and trends, and consider the value of clinical initiatives on the outstanding IBNR.

ESSENTIAL DUTIES AND RESPONSIBILITIES

This list may not include all of the duties that may be assigned.

Oversees the monthly accrual process, ensuring timely and accurate estimation of surplus/deficits related to risk contracts.

Collaborates with cross-functional teams, including accounting, FP&A, managed care, clinical, and operations, to reconcile IBNR reserves with financial statements, provide insights into variances and trends, and consider the value of clinical initiatives on the outstanding IBNR.

The role will support the development of a reserving methodology, documentation and data validation controls.

Partnering with Finance on financial reporting matters and audit requests.

Supports reviewing the payor’s estimated contract balance against accrued balances and provide data-backed findings to the payor, while considering the contract settlement terms. Role will require working directly with payors related to financial settlements and inputs to those settlements.

Monitors the sufficiency of reserves, the development of reserve ranges, and supporting recommendations on provisions for adverse deviations.

This role will involve moderately complex to complex issues where the analysis of situations requires in-depth data analysis and consideration of variable factors. Critical skills for this role will be possessing the ability to perform data analysis and communicating the impact on the contract balances.

This role will require being flexible and a collaborative business partner in a growing organization.

SUPERVISORY RESPONSIBILITIES

Oversee the value-based care reserving function at Pediatric Associates.

QUALIFICATIONS

EDUCATION: Bachelor’s degree in Actuarial Science, Finance, Healthcare Administration or other related field.

EXPERIENCE:

10 or more years of healthcare actuarial work experience required.

3 years of experience in a health insurance reserving capacity.

Experience in establishing provider contract reserves and monitoring of settlements.

Experience in Managed Medicaid.

LICENSURE / CERTIFICATION

ASA or FSA designation

Member of the American Academy of Actuaries

KNOWLEDGE, SKILLS AND ABILITIES
Skills to develop and maintain actuarial models to evaluate financial performance, risk, and opportunities associated with value-cased care arrangements.
Strong proficiency in actuarial modeling software and statistical analysis tools (e.g. Excel, SQL, SAS, R, Python)
Strong communication skills, including using exhibits and presentations to translate technical issues for non-actuarial audiences.
In-depth understanding of medical economics principles, including healthcare cost analysis, reimbursement methodologies, risk stratification and financial performance metrics.
Experience in conducting medical cost trend analysis, utilization review, and forecasting to support strategic decision-making.
Ability to think holistically through a project

Location: Pediatric Associates · Patient Contact Center
Schedule: Full Time, Remote

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