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Kaiser Permanente Careers

Accounting, Actuarial & Finance

Support the Bottom Line — and the Big Picture

Create the financial strategies that affect our patients, medical centers, and future. On this team, you'll provide the strategy recommendations that drive operational and process improvement, as well as face challenging opportunities to influence the future of health care.

Risk Analyst IV

Location: Renton, WA Additional Locations:
Job Number: 761579 Date posted: 12/27/2018
Description:
**THE RISK ADJUSTMENT SERVICES TEAM IN ACTUARIAL SERVICES IS FOCUSED ON MA & ACA RISK ADJUSTMENT, RISK SCORE MODELING, ANALYTICS, REPORTING, PERFORMANCE MANAGEMENT AND CONSULTING.

THIS POSITION WORKS CROSS FUNCTIONALLY WITH WASHINGTON PERMANENTE MEDICAL GROUP, PROVIDER RELATIONS, MEDICARE FINANCE, HEALTH INFORMATION MANAGEMENT, BILLING/RESOLUTE, AND HEALTH PLAN OPERATIONS TEAMS.

RESPONSIBILITIES INCLUDE ANALYTICS, FINANCIAL MODELING, VENDOR MANAGEMENT, RISK SCORE FORECASTING, DOCUMENTATION, DESIGN AND EXECUTION OF SOX CONTROLS.

PREFERRED QUALIFICATIONS:

SQL


This position works with a team of analysts and actuaries to support premium rate setting, provider contract analysis, network analysis, Medicare bid submissions, underwriting and other financial risks associated with health insurance. The Risk Analyst IV provides basic and complex analysis of business strategies, and may be asked to maintain or build models to support their work.

Essential Responsibilities:

  • 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.

  • Assumption setting for line of business / account / provider: Set assumptions and/or make decisions that establish appropriate risk positions for the organization; may impact revenue or allowed claims cost of up to $10 million. Develop supportive factors and/or adjustments based on credible experience. Collect and evaluate data for rating and management purposes. Evaluate changes in provider network, including provider compensation, scope or utilization changes, for trend-setting activities. Collaborate with Sales, Product Development, and/or Provider Services on rate negotiations.

  • 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.

  • Basic Qualifications:

    Experience

  • Minimum seven (7) years of related business/financial experience.

  • Education

  • Bachelor's degree in business administration, finance, mathematics, actuarial science or related fields OR a minimum four (4) years of experience in a directly related field.

  • High School Diploma OR General Education Development (GED) is required.

  • License, Certification, Registration

  • N/A


  • Additional Requirements:

  • Responsible for deploying underwriting/actuarial techniques and knowledge to make appropriate rate decisions that can impact up to $5 million in revenue or claims.

  • 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.

  • Excellent verbal, written and presentation communication skills; Excellent customer service and organizational skills.

  • Expertise in financial and risk modeling.

  • Demonstrated ability to apply actuarial and underwriting principles in day-to-day problems.

  • Ability to develop and apply tactics to achieve organizational business strategy.

  • Ability to identify and solve problems.

  • Demonstrated understanding of insurance principles.

  • Demonstrated working knowledge and skills in financial modeling; Familiarity of financial transaction flow within operational and financial systems.

  • Proficient in Microsoft Office applications.


  • Preferred Qualifications:


  • Eight (8) years of related business/financial experience.

  • Bachelor's degree in business administration, finance, mathematics, actuarial science or related fields.
  • Primary Location: Washington,Renton,Renton Administration - Baker 1300 SW 27th St. Scheduled Weekly Hours: 40 Shift: Day Workdays: Mon, Tue, Wed, Thu, Fri Working Hours Start: 9:00 AM Working Hours End: 5:00 PM Job Schedule: Full-time Job Type: Standard Employee Status: Regular Employee Group/Union Affiliation: Salaried, Non-Union, Exempt Job Level: Individual Contributor Job Category: Accounting, Finance and Actuarial Services Department: Risk Adjustment Services Travel: No Kaiser Permanente is an equal opportunity employer committed to a diverse and inclusive workforce. Applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy), age, sexual orientation, national origin, marital status, parental status, ancestry, disability, gender identity, veteran status, genetic information, other distinguishing characteristics of diversity and inclusion, or any other protected status.

    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.

    About Accounting, Finance, & Actuarial Careers

    Accounting Careers

    Members of our accounting team support corporate projects and lend insight to areas such as financial reporting, tax planning and preparation, and audit management. This team also includes our audit professionals, who partner with financial and operational groups across the organization to analyze budgets and streamline procedures.

    Finance Careers

    Supporting critical business functions such as financial services, national Medicare finance, strategic planning, auditing, and corporate finance, our finance professionals develop the strategies that enable us to meet our financial goals.

    Actuarial Careers

    Applying probability and statistics to the practical problems of insurance, our actuarial team performs a variety of duties, including calculating the cost of premiums and policy values, preparing statistical studies, and forecasting financial results.

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