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

San Antonio, Texas, United States

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Not SpecifiedCompensation

Mid-level (3 to 4 years), Senior (5 to 8 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
Experience in more than two functions (e.g., modeling, pricing, rate filing, reporting & analysis, reserving or trending)
Demonstrated project management skills with the ability to drive work independently and effectively lead through collaboration
Experience in managing large healthcare claim datasets and conducting trend analysis
Advanced knowledge of Databricks, SQL, or Python

Responsibilities

Own and manage Medicaid claims analytics dataset using Databricks
Ensure data accuracy, completeness, and readiness to support modeling, reporting, and decision-making
Evaluate the downstream impacts of data changes on actuarial models, reporting tools, and financial results
Lead and manage data-related projects from scoping through post-production validation, partnering with teammates to implement data transformations, automation, and enhancements
Conduct in-depth analysis of healthcare claims to identify data issues and optimization opportunities
Work with actuarial, financial, and clinical teams to assess and determine optimal data solutions
Provide strategic recommendations on data architecture and improvements
Support team in identification of cost drivers, utilization patterns, and anomalies in Medicaid medical claims data
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
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
Exercise independent judgment and decision making regarding job duties and related tasks under minimal supervision

Skills

Key technologies and capabilities for this role

DatabricksMedicaid claims analyticsproject managementdata transformationsautomationhealthcare claims analysisroot cause analysisdata integrityactuarial modelingfinancial forecastingbusiness intelligencedata architecture

Questions & Answers

Common questions about this position

What qualifications are required for the Actuary, Medicaid Trend Analytics role?

A Bachelor's Degree is required, along with FSA or ASA plus relevant advanced degree, recent work experience, or other professional designations, MAAA, experience in more than two actuarial functions like modeling, pricing, or trending, demonstrated project management skills, experience managing large healthcare claim datasets, and advanced knowledge of Databricks, SQL, or Python.

What are the preferred skills for this position?

Preferred skills include the ability to translate complex data into actionable insights, effective communication for technical and non-technical audiences, and skill in gathering customer input to translate into clear business requirements.

Is this a remote position or does it require office work?

This information is not specified in the job description.

What is the salary or compensation for this role?

This information is not specified in the job description.

What experience stands out for a strong candidate applying to this actuary role?

Candidates with FSA or ASA credentials, MAAA designation, experience across multiple actuarial functions, project management skills, and advanced proficiency in Databricks, SQL, or Python for managing large healthcare datasets will be strongest.

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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