Risk Analyst III
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- Analyze performance of line of business / account / provider: Assess overall LOB/account risk including competitive analysis, broker behavior, network cost profile, legislative and regulatory impacts, payer goals and contributions. Build reports and provide analysis that provide clear, actionable information to clients and/or the organization. Obtain adequate peer review of own work, and provide review for the work of others.
- Analyze health care data: Evaluate data files and data elements to understand premium, claim, and exposure experience. Evaluate credibility based on population size and prior predictive behavior of the pool / account. Identify potential data issues and research solutions.
- Development of Actuarial Tools and Data Resources: Create and maintain models (such as rate model and benefit pricing tools) that support the analysis of business strategy and financial risk management. Document models, tools, assumptions and data elements as necessary for compliance and continuity.
- Minimum five (5) years of related business/financial experience.
- Bachelors degree in business administration, finance, mathematics, actuarial science or related field OR four (4) years of experience in a directly related field.
- High School Diploma or General Education Development (GED) required.
- Demonstrated understanding of insurance principles.
- Demonstrated working knowledge and skills in financial modeling.
- Familiarity of financial transaction flow within operational and financial systems.
- Excellent verbal, written and presentation communication skills.
- Excellent customer service and organizational skills.
- Ability to identify and solve problems.
- Demonstrated working knowledge and skills in the analysis of health-care claims data and other related cost.
- Demonstrated knowledge in analysis of member, purchase, and provider contracting.
- Proficient in Microsoft Office applications.
- Seven (7) years of related business/financial experience.
- Bachelors degree in business administration, finance, mathematics, actuarial science or related field.
External hires must pass a background check/drug screen. Qualified applicants with arrest and/or conviction records will be considered for employment in a manner consistent with federal and state laws, as well as applicable local ordinances, including but not limited to the San Francisco and Los Angeles Fair Chance Ordinances.