[Remote] Actuary, Medicaid Trend Analytics and Data Management at Humana

San Antonio, Texas, United States

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Not SpecifiedCompensation

Senior (5 to 8 years), Expert & Leadership (9+ years)Experience Level

Full TimeJob Type

UnknownVisa

Healthcare, InsuranceIndustries

Requirements

Bachelor's Degree
FSA or ASA plus relevant advanced degree, recent and relevant work experience, and/or other relevant professional designations
MAAA
Strong communication skills
Experience in more than two functions (e.g., modeling, pricing, rate filing, reporting & analysis, reserving or trending)
Experience in managing large healthcare claim datasets and conducting trend analysis
Deep understanding of healthcare claims taxonomy (service categories, such as LTSS)
Advanced knowledge of Databricks, SQL, or Python

Responsibilities

Design and maintain Medicaid claims analytics dataset using Databricks
Conduct in-depth analysis of healthcare claims utilizing revenue codes, CPT/HCPCS, ICD-10 diagnosis codes, DRG, etc
Partner with actuarial, financial, and clinical teams to align on data definitions, methodologies, and reporting
Identify cost drivers, utilization patterns, and anomalies in Medicaid medical claims data
Maintain dashboards to communicate key trends to stakeholders
Ensure data integrity by developing and executing necessary processes and controls around the flow of data
Collaborate with stakeholders to understand business needs/issues, troubleshoot problems, conduct root cause analysis, and develop cost effective resolutions for data anomalies
Advise executives to develop functional strategies (often segment specific) on matters of significance
Exercise independent judgment and decision making on complex issues regarding job duties and related tasks under minimal supervision
Analyze and forecast financial, economic, and other data to provide accurate and timely information for strategic and operational decisions
Establish metrics, provide data analyses, and work directly to support business intelligence
Evaluate industry, economic, financial, and market trends to forecast the organization's short, medium and long-term financial and competitive position

Skills

Key technologies and capabilities for this role

DatabricksMedicaid claims analyticsCPT/HCPCSICD-10DRGrevenue codesactuarial analysisforecastingdata integritydashboardsroot cause analysishealthcare claimsSQL

Humana

Health insurance provider for seniors and military

About Humana

Humana provides health and well-being services, focusing on Medicare Advantage plans for seniors, military personnel, and communities. Their plans include HMO, PPO, and PFFS options, designed to improve health outcomes through comprehensive and flexible coverage. Humana's revenue comes from government contracts and member premiums, and they aim to maintain high renewal rates by offering quality service and competitive benefits. The company stands out by fostering a culture of inclusivity and belonging among its employees, while also ensuring accessibility for all members, including offering free language interpreter services. Humana's goal is to deliver value to its members through an extensive provider network and innovative health solutions.

Louisville, KentuckyHeadquarters

1961Year Founded

IPOCompany Stage

Social Impact, HealthcareIndustries

10,001+Employees

Risks

Potential over-reliance on AI could disrupt operations if systems fail or are compromised.

Rising medical costs and tightening Medicare reimbursements may strain financial performance.

Leadership change with new CEO Jim Rechtin could lead to strategic disruptions.

Differentiation

Humana is a leader in Medicare Advantage plans, focusing on seniors and military personnel.

The company emphasizes inclusivity, offering free language interpreter services for accessibility.

Humana leverages AI and cloud technologies through a partnership with Google Cloud.

Upsides

Humana's investment in Healthpilot enhances digital enrollment for Medicare options.

The company is the first insurer to cover TMS therapy for adolescent depression.

Humana's focus on value-based care aims to improve outcomes for kidney disease patients.

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