Pricing Actuary - Pharmacy (work from home United States)
Location: Danville, Pennsylvania
Type: Full Time
Internal Number: R-10629
Supports the daily operations associated with the Health Plan's Actuarial Department. Assists in the development of rate filings, trend analysis, revenue strategy, forecasting, reserving, data management and analytics. Monitors the impact of strategic initiatives, regulatory reforms and legislation, and communicates effectively with peers and leadership
Experienced actuary needed to manage the actuarial and underwriting functions for the Commercial employer group pharmacy product line including:
Pricing and analysis
Modeling and underwriting
Optimization of formulary
Rebate and 340B analysis
Performs the pricing of products, including but not limited to building sound pricing models and tools, working with internal staff to arrive at sound products and strategies, and working with regulatory authorities to get approval of products and pricing.
Serves as subject matter expert for regulatory reform and legislative changes, while quantifying impact of change, and identifying potential risks to successful implementation.
Supports the development of claim and premium deficiency reserves while working with auditors to arrive at mutually acceptable conclusions.
Guides the forecasting, analytic, underwriting, and performance monitoring functions.
This includes trend development, monitoring financial performance relative to budget/pricing, evaluating provider, vendor, and reinsurance agreements, and studying performance relative to external benchmarks.
Supports data management by providing direction and oversight to IT teams for appropriate data aggregation, partitioning, and extract rules to meet analytic and reporting needs.
Provides guidance and support to upcoming actuarial talent.
Work is typically performed in an office environment. Accountable for satisfying all job specific obligations and complying with all organization policies and procedures. The specific statements in this profile are not intended to be all-inclusive. They represent typical elements considered necessary to successfully perform the job.
*Will consider both Associate and Fellow Actuaries with pharmacy pricing experience.
Bachelor's Degree- (Required)
Minimum of 5 years-Related work experience (Required)
Certification(s) and License(s)
Member of Society of Actuaries - Society of Actuaries
OUR PURPOSE & VALUES: Everything we do is about caring for our patients, our members, our students, our Geisinger family and our communities. KINDNESS: We strive to treat everyone as we would hope to be treated ourselves. EXCELLENCE: We treasure colleagues who humbly strive for excellence. LEARNING: We share our knowledge with the best and brightest to better prepare the caregivers for tomorrow. INNOVATION: We constantly seek new and better ways to care for our patients, our members, our community, and the nation. SAFETY: We provide a safe environment for our patients and members and the Geisinger family We offer healthcare benefits for full time and part time positions from day one, including vision, dental and domestic partners.* Perhaps just as important, from senior management on down, we encourage an atmosphere of collaboration, cooperation and collegiality. We are an Affirmative Action, Equal Opportunity Employer Women and Minorities are Encouraged to Apply. All qualified applicants will receive consideration for employment and will not be discriminated against on the basis of disability or their protected veteran status.
We are an Affirmative Action, Equal Opportunity Employer Women and Minorities are Encouraged to Apply. All qualified applicants will receive consideration for employment and will not be discriminated against on the basis of disability or their protected veteran status.
At Geisinger, our innovative ideas are inspired by the communities we serve – like our Fresh FoodFarmacy, a program that delivers life-saving healthy alternatives to patients with diabetes. With additional tools like our MyCode Community Health Initiative, one of the first health system genome sequencingprograms, and our new asthma app suite that we developed in partnership with AstraZeneca, it’s no wonder we’re ranked one of the Top 5 Most Innovative Healthcare Systems by Becker's Hospital Review. We continually work towards continuous improvement in a culture where everyone has a voice and firmly believe that better begins with all of us.Founded more than 100 years ago, Geisinger serves more than three million residents throughout central, south-central and northeastern Pennsylvania and southern New Jersey. Our physician-led system is comprised of 30,000 employees, including 1,600 employed physicians, and consists of 13... hospital campuses, the Geisinger Health Plan, Geisinger Commonwealth School of Medicine and two research centers. What you do at Geisinger shapes the future of health and improves lives – for our patients, communities, and you.