It's an exciting time to join the WellSense Health Plan, a growing regional health insurance company with a 25-year history of providing health insurance that works for our members, no matter their circumstances.
Job Summary:
The Manager of Risk Adjustment and Trend Analytics is a key member of the Finance management team. Under supervision of the V.P of Financial Planning and Performance Analysis, the Manager oversees risk adjustment analysis primarily related to the MassHealth Medicaid and New Hampshire Medicaid lines of business, directly impacting and improving the revenue for these products. The Manager also leads the measurement and reporting of medical expense trends for all lines of business, with a goal of identifying medical expense savings opportunities and recommending performance improvement initiatives.
Our Investment in You:
* Full-time remote work
* Competitive salaries
* Excellent benefits
Key Functions/Responsibilities:
Risk Adjustment responsibilities include:
Trend Analytics responsibilities include:
Other Functions/Responsibilities:
* Directs a team of health care analysts/analytic managers using SAS and other query languages for data mining, reporting, evaluation and outcomes measurement. Lead analysts in the design, development and implementation of evaluation methods and tools to measure the effectiveness of both internally developed medical management initiatives or externally purchased vendor programs.
* Responsible for staff hiring, work allocation and scheduling, training and professional development, performance management and related supervisory activities.
Supervision Exercised:
* Manages up to 4 staff.
Supervision Received:
* General supervision is received weekly.
Qualifications:
Education:
* Bachelor's Degree in Mathematics, Actuarial Science, Finance, Economics or related field required; Associate of Society of Actuaries (ASA).
Preferred/Desirable:
* Master's Degree preferred.
* Background in managed healthcare, insurance operations
* 2+ years of prior experience managing team of analyst
* Fellow of the Society of Actuaries (FSA) Preferred.
Experience:
* A minimum of five years of progressively responsible experience in, actuarial analysis, health care analytics trend analysis, risk adjustment analysis, data modeling, informatics or similar analysis. Commensurate educational experience in related field will be considered.
* Working knowledge of at least one of the following risk adjustment methodologies DxCG, CDPS+Rx, CMS Medicare Advantage HCC Model, ACA HCC Model.
Competencies, Skills, and Attributes:
* Expert analyst with an ability to translate findings into actionable opportunities.
* Proficiency working with risk adjustment models.
* Ability to use well developed interpersonal skills to lead and direct the efforts of others, both internally and externally required.
* Proficient in excel, SQL and SAS or other statistical software.
* Working knowledge of MS tools, including MS Office products, MS Access, MS Project.
* Must be able to conceptualize and envision the impact of change, and propose new ways to do business.
* Ability to meet deadlines, multi-task, problem solve and use appropriate technology to analyze business problems. Project management skills a plus.
* Strong communications skills, both verbal and written, are required.
* Strong understanding of health care data and analytical methodologies.
* Strong team player.
* Effective collaborative and proven process improvement skills.
Certification or Conditions of Employment:
* Pre-employment background check
Working Conditions and Physical Effort:
* Regular and reliable attendance is an essential function of the position.
* Work is normally performed in a typical interior/office work environment or remotely.
* No or very limited physical effort required. No or very limited exposure to physical risk.
About WellSense
WellSense Health Plan is a nonprofit health insurance company serving more than 740,000 members across Massachusetts and New Hampshire through Medicare, Individual and Family, and Medicaid plans. Founded in 1997, WellSense provides high-quality health plans and services that work for our members, no matter their circumstances. WellSense is committed to the diversity and inclusion of staff and their members.
Qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, disability or protected veteran status. WellSense participates in the E-Verify program to electronically verify the employment eligibility of newly hired employees