Job Description

Actuarial and Financial Modeling:

• Develop and maintain actuarial and financial models to support business needs and strategic goals.
• Design and develop financial models to quantify the impact of proposed cost-saving initiatives and forecast potential outcomes.
• Assist in enhancing actuarial models and ensuring accurate validation of data and results using in-house models or actuarial software.

Advanced Data Analysis:

• Conduct advanced data analysis to assess claims trends, approval and denial patterns, and cost drivers.
• Focus on minimizing waste and controlling costs through detailed analysis of financial data.
• Identify trends, patterns, and anomalies using statistical and data visualization tools to provide actionable insights.

Risk and Opportunity Assessment:

• Assess and analyze financial risks and opportunities by applying actuarial methods and conducting actuarial analyses.
• Stay current with actuarial research, industry standards, assumptions, competition, and the legal and regulatory environment to inform decision-making.
• Post-Implementation Assessments:
• Support post-implementation assessments to evaluate the effectiveness and impact of cost-saving initiatives.
• Ensure continuous improvement and long-term sustainability of implemented cost-saving strategies.

Collaboration and Influence:

• Collaborate proactively with stakeholders, including leadership, clinical teams, and customer success teams, to understand business needs and challenges.
• Translate complex actuarial concepts into clear, non-technical recommendations for business partners and stakeholders.
• Act as a trusted advisor by providing expert guidance and strategic insights to influence decision-making and ensure alignment with business goals.

Cost-Saving Initiatives:

• Support cost-saving projects by providing analysis and recommendations based on actuarial models and financial forecasting.
• Develop and present executive-level reports and presentations summarizing cost-saving achievements and project performance.
• Identify and implement innovative approaches, including new technologies, data analysis tools, and process improvements, to optimize cost savings.

Reporting and Strategic Recommendations:

• Prepare and present detailed reports and strategic recommendations to leadership and stakeholders on financial outcomes and performance metrics.

Qualifications

Requirements and Qualifications:

• 2+ years of experience in healthcare analytics, cost containment, or similar roles in the healthcare industry, preferably within a payer, provider, or managed care setting.
• Bachelor's degree in Actuarial Science, Mathematics, Statistics, Finance, Economics or related field Required. ASA (Associate of the Society of Actuaries) or actively working towards it. Minimum of three Society of Actuaries (SOA) actuarial exams passed.
• Familiarity with Pharmacy benefits, health care, prior authorization, utilization management processes is highly desirable.
• Strong understanding of healthcare cost drivers claims data, and prior authorization processes. Strong data interpretation, statistical analysis and problem-solving skills
• Ability to transform complex data into actionable insights and clear, concise reports.
• Proficiency in data analytics and visualization tools, such as SQL, Tableau, Power BI, and advanced Excel.
• Strong interest and understanding of prior authorization data, claims and SDOH data
• Proficient in R, SQL, Python, Scala, AWS (S3, Airflow, Athena, Spark)
• Excellent interpersonal skills to work with end users to develop QC metrics
• Passionate about improving the U.S. healthcare system and helping ensure every patient receives the best care possible.
• Self-starter, able to work independently, able to succeed in a fast-paced, high-intensity environment

Additional Information

Additional Information:

• Base Salary: $85-$115K/year
• Remote position
• Annual bonus eligible
• Comprehensive Benefits Package:
• Medical, Pharmacy, Dental, Vision
• Life Insurance
• Stock Options
• 401(k) with Company Match
• PTO
• Full-time position
• Dynamic, collaborative work environment
• Opportunity to make real impact at a growing Public Benefit Corporation

VIVIO Health is an Equal Opportunity Employer. All information will be kept confidential according to EEO guidelines.

Please be advised that job opportunities will only be extended after a candidate submits a completed job application and goes through our interview process, including 1:1 and/or group interviews via phone, video conferencing, and/or in-person. All legitimate correspondence from a VIVIO employee will come from our Smart Recruiter Applicant Tracking System "@smartrecruiter.com" or "@viviohealth.com" email accounts.