The Senior Actuarial Analyst is responsible for applying actuarial principles, statistical modeling, and financial analysis to support GLIN IPA's value-based reimbursement programs, provider and payer contracting, and enterprise financial planning. This role develops predictive models, estimates financial risk, designs innovative reimbursement methodologies, and evaluates contract performance to support strategic decision-making.
The Senior Actuarial Analyst partners with finance, analytics, contracting, and executive leadership to develop reserve estimates, forecast financial performance, validate value-based payment methodologies, and provide actionable insights that improve organizational performance and support GLIN's transition to value-based care.
Key Duties and Responsibilities:
- Consistently observes safety and security procedures. Reports potentially unsafe conditions to appropriate personnel.
- Develop actuarial models to support provider and payer reimbursement strategies, value-based payment methodologies, and innovative risk-sharing arrangements.
- Design and maintain predictive financial models using actuarial, statistical, and probabilistic techniques to forecast medical costs, shared savings, incentive payments, and overall contract performance.
- Develop reserve estimates and accrual methodologies for value-based reimbursement programs, ensuring appropriate recognition of financial liabilities and supporting accurate financial reporting.
- Analyze utilization, claims, quality, financial, and clinical data to identify trends, quantify financial risk, and evaluate the performance of provider incentive and payer reimbursement programs.
- Design, validate, reconcile, and oversee physician incentive payment methodologies and other value-based reimbursement calculations.
- Support provider and payer contract negotiations by modeling financial scenarios, evaluating risk exposure, and assessing the financial impact of proposed reimbursement arrangements.
- Conduct variance analyses on financial performance, reserves, and actuarial assumptions, recommending adjustments based on emerging experience and changing utilization patterns.
- Develop and maintain actuarial models, analytical tools, dashboards, and predictive forecasts using Excel, SQL, and statistical methodologies to support executive decision-making, financial planning, reimbursement strategy, and performance evaluation across Commercial, Medicare Advantage, Medicaid, and Government programs.
- Serve as strategic analytical partner by preparing executive-level analyses and recommendations, supporting budgeting and long-range planning, consulting with internal and external stakeholders on value-based reimbursement strategies, driving process improvements and automation, and contributing to enterprise growth and performance improvement initiatives.
- All other duties as assigned.
Minimum Requirements:
- Bachelor's degree in actuarial science, Mathematics, Statistics, or other closely related field required.
- 3 years as an actuarial analyst in health insurance or value-based care required.
- Successful completion of two SOA exams required.
We offer an outstanding benefits package including health, dental, 401K, vacation, PTO, and a great working environment. Pay range $85,911.54 ‒ $118,108.09
The referenced pay range represents the minimum and maximum compensation for this job. Individual annual salaries/hourly rates will be set within the job’s compensation range and determined by considering factors including, but not limited to, market data, education, experience, qualifications, and expertise of the individual, as well as internal equity considerations. Equal Employment Our culture encourages individual development, embraces an inclusive environment, rewards innovative excellence, and leads New York in provider and patient satisfaction. Great Lakes Integrated Network IPA (GLIN IPA) values diversity, inclusion, and equity as matters of fairness and effectiveness. We are committed to hiring and retaining a staff that reflects the diversity of the communities we serve, fostering an inclusive working environment where staff of all backgrounds feel welcomed and engaged. Great Lakes Integrated Network is an Equal Opportunity Employer