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Job Description:

Summary:

The Healthcare Statistical Analyst & PFO performs technical services within the actuarial or risk adjustment department that support of the Health Plans operations which monitors and maintains financial solvency through the understanding of current data & environment and modeling of future events. This role interacts with internal and external partners and Regulatory agencies. This role monitors trends, bring forward opportunities and insights found in the data to the applicable audiences. This position supports leadership by providing statistical information and analysis needed to make informed decisions, identifies trends, and utilizes data mining techniques and development of advanced predictive models.

As a Product Family Owner, this role is additionally responsible for identifying, prioritizing and overseeing the execution of innovative operational strategies and work in support of the health plan and to identify future growth opportunities in the Systems space. This role serves as the primary interface between the business stakeholders, the Team Product Owners (TPO) & development team(s) with the emphasis on representing the customer/user community to the development teams. The PFO decides on the high-level functionality in collaboration with their business partners, sets goals, sets suite-level priorities and is ultimately accountable for the entire product and/or suite of products.

Essential Accountabilities:

Level I

+ Updates existing and aids in the creation of new analysis pertaining to benefit designs, claims experience, Value Based Payment (VBP) programs and valuation of internal and externally led claims savings and risk adjustment initiatives and communicates with other departments on various initiatives.

+ Maintains existing processes including but not limited to reserve programs, pricing files, benefit relativity tables, trend analysis, risk score analysis, VBP and vendor financial settlements, ROI work. Draws together facts and input from a variety of data sources.

+ Leads and supports departments projects, including assisting with the development of projections (financial, claims, risk score, trend, utilization, savings, etc.), unpaid claim liability estimates and identification of areas for savings.

+ Initiates and leads efforts relating to and independently compiles, analyzes, and researches data across complex data ecosystem including operational and analytical data platforms to develop insightful and effective reporting and dashboards, support data quality, provider recommendations, and coordinate with staff.

+ Develops analyses concerning complex issues and trends, coordinating with several different disciplines and staff.

+ Demonstrates keen judgment on involved and complex assignments; devises methods and procedures to meet unusual conditions and makes original contributions to the solution of very difficult problems. Problem solving is complex and involves critical issues.

+ Reconciles Data Warehouse data with corporate financials or encounter submissions and identifies and develops corrective action with regards to Data Warehouse integrity issues.

+ Proposes and assists in the development of process improvements utilizing system and software applications to full potential and participates in activities and projects as directed.

+ Reviews and ensures pricings are consistent with established profitability targets for relevant business segments.

+ Creates and maintains documentation related to data analysis, data models, and data mapping which includes creating technical documentation, process documentation and training materials.

+ Utilizes an exceptional understanding of health plan operations, systems, and customers.

+ Creates a backlog of minimum viable products.

+ Oversees the design, development, implementation, and socialization of operational system strategy and communications for the organization across the Health Plan.

+ Strategically leads and/or participates in innovative thinking and idea generation that will transform the customer experience.

+ Works to integrate data analytics, performance metrics, competitive and market analysis, and company goals to drive prioritization of set initiatives.

+ Develops relationships with key areas vital to the success of all products within their product family to understand their vision, strategies, and desired capabilities needed to integrate them into a comprehensive strategy and roadmap.

+ Serves as Change management model champion and change agent for this role and the new process.

+ Identifies trends and innovative opportunities in anticipation of future needs of our customers and organization.

+ Understands and aligns operational capabilities roadmap and recommendations to Federal regulations, compliance standards, and industry best practices.

+ Aggregates constituent backlogs into a single prioritized product family backlog

+ Understands, manages, and communicates prioritization of product features with a mind toward user and business benefits/tradeoffs.

+ Provides documentation as needed (i.e. vision board, scope, workflow, use cases, requirements, and other materials) to support the teams.

+ Defines release success criteria and ensures the success metrics are realized.

+ Works with the TPO to elaborate requirements including high-level Conditions of Acceptance (CoAs).

+ Interfaces with leaders and/other PPOs to manage dependencies with integrated projects.

+ Proactively manages product family-level changes in project scope and mitigates potential risks thereof.

+ Maintains/develops relevant industry knowledge and relationships to further knowledge and product family expertise.

+ Collaborates with the Leadership Team to implement key initiatives (Maximize Quality, Surmount Delivery, Enhanced Predictability, Control Risk, Scale the Organization, Create an Innovative Organization, Unify the Organization).

+ Mentors' others in the product family when needed.

+ Consistently demonstrates high standards of integrity by supporting the Lifetime Healthcare Companies’ mission and values, adhering to the Corporate Code of Conduct, and leading to the Lifetime Way values and beliefs.

+ Maintains high regard for member privacy in accordance with the corporate privacy policies and procedures.

+ Regular and reliable attendance is expected and required.

+ Performs other functions as assigned by management.

Level II (in addition to Level I Accountabilities)

+ Offers strategic recommendations on the analysis of data, data collection, and integration using the knowledge of best practices and business requirements.

+ Conduct exploratory, descriptive, and inferential data analysis using statistical and machine learning techniques.

+ Represents the Department on special projects involving other areas of the company or external constituents.

+ Partners and leads projects including stakeholders from a variety of departments.

+ Interprets how regulatory changes affect Health Plan and develops impact analyses.

+ Recommends departmental annual performance goals.

+ Collaborates with senior leadership in meeting corporate goals and strategic decision making.

Minimum Qualifications:

NOTE: We include multiple levels of classification differentiated by demonstrated knowledge, skills, and the ability to manage increasingly independent and/or complex assignments, broader responsibility, additional decision making, and in some cases, becoming a resource to others. In addition to using this differentiated approach to place new hires, it also provides guideposts for employee development and promotional opportunities.

All Levels

+ Five (5) years of related experience required, with participation in Society of Actuaries (SOA) exams preferred.

+ Bachelor’s degree in Math, Statistics, Economics, Medical Informatics, Actuarial Science or relevant field required.

+ Proficient programming skills in SQL, SAS, VBA, or similar programming language is preferred.

+ Experience as a process/project/program manager, with demonstrated accomplishments delivering project features/capabilities preferred.

+ Experience with Agile or Scaled Agile experience (either working in Agile/SAFe environment preferred or experience rolling out new to organization Agile methodology) or a genuine willingness to learn.

+ Ability to prioritize, multitask, and maintain multiple simultaneous projects, with a strong ability to recognize and automate repetitive tasks, and demonstrated experience leading projects or process improvement initiatives.

+ Strong interpersonal, verbal and written communications and organizational skills and ability to engage at the executive level, with the a bility to write and communicate complex concepts.

+ High level understanding of non-Actuarial functions such as Rating & Underwriting, Finance, Provider Contracting, Analytics & Data Technology, Population Health Engagement, Marketing & Sales, etc., and how they impact Health Plan operations and financials.

+ Ability to work & perform complex modeling independently, with high level of self-motivation to improve processes.

+ Self-motivated, able to analyze problems and identify solutions with minimal direction, flexible, able to meet deadlines, and work well in a fast-paced, high volume team environment.

Level II (in addition to Level I Qualifications)

+ Seven (7) years of related experience required, with participation in Society of Actuaries (SOA) exams preferred.

+ Experience as an Agile Product Owner or equivalent preferred.

+ Advanced understanding of non-Actuarial functions such as Rating, Underwriting, Accounting, Provider Contracting, Network Management, Product Development, Medical Management, etc., and how they impact Health Plan operations and financials.

+ Advanced ability to independently communicate analytical findings at the appropriate level of detail for receiving audience.

+ CSM or CSPO Certification or Lean Six Sigma Green Belt a plus.

+ Advanced communication skills with the ability to present complex concepts to both actuarial and non-actuarial audiences.

Physical Requirements:

+ Ability to work prolonged periods sitting and/or standing at a workstation and working on a computer.

+ Ability to travel across the Health Plan service region for meetings and/or trainings as needed.

+ Ability to work in a home office for continuous periods of time for business continuity.

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In support of the Americans with Disabilities Act, this job description lists only those responsibilities and qualifications deemed essential to the position.

Equal Opportunity Employer

Compensation Range(s):

Level I: Grade E6: Minimum $79,068 - Maximum $142,322

The salary range indicated in this posting represents the minimum and maximum of the salary range for this position. Actual salary will vary depending on factors including, but not limited to, budget available, prior experience, knowledge, skill and education as they relate to the position’s minimum qualifications, in addition to internal equity. The posted salary range reflects just one component of our total rewards package. Other components of the total rewards package may include participation in group health and/or dental insurance, retirement plan, wellness program, paid time away from work, and paid holidays.

With about 4,000 employees, 31 counties, and serving the needs of over 1.5 million members, you can imagine the gamut of skills it takes to keep our organization growing and our members flourishing. As an internal job seeker, this means growth and development in many directions, divisions, and roles.Take a look at information regarding our hiring process here. https://lifethc.sharepoint.com/sites/HumanCapitalManagement/SitePages/Talent-Acquisition-%26-Onboarding.aspx#hiring-process All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.