Everside Health is a national on-site, near-site and virtual primary care provider on a mission to fix America’s broken healthcare delivery model. We are technology-driven and care-obsessed. With our expanding reach, scale, and expertise, we truly make an impact on a national level by serving more clients and improving the health of more people, all while achieving the goal of reducing the total cost of healthcare for employers and organizations. That’s why we exist – and our relentless focus through care delivery access, technology, transparency, and relationships drives us every day.
Essential Duties & Responsibilities
This position will be one of strategic importance to the future of Everside Health in that this role helps summarize likely clinic costs, estimate healthcare benefits that clients can expect to receive, and then to demonstrate the value that clients receive from Everside Health. This position will help the industry transform healthcare by helping the organization and clients understand the facts related to both healthcare improvement (via electronic medical and other health information) as well as health care costs (via claims) – all made possible by a proven new approach to offering primary care services through employers. This information will also be to help providers continuously improve the impact that clinics and providers make. The ideal candidate will be energized by the opportunity to use information and insights to proactively identify opportunities to continuously improve the Everside Health business model and demonstrate the value of the services provided.
The person in this position will need to collaborate well on a cross-functional basis with multiple key stakeholders. This position will work collaboratively with finance, sales and operations to assist with pricing that will deliver an acceptable return for Everside Health and consider the client ROI while being competitive. This position will also need to work closely with sales and operations to tailor the solutions and related costs/benefits to meet the needs of clients (individually and overall). This position will help develop internal reporting to focus the medical team’s efforts on targeted patients and to measure progress made (via the EMR and claims history). Finally, this position will help prepare annual reports for clients that demonstrate the value of the Everside Health clinic regarding services provided, clinical progress, return on investment and other relevant information.
- Under the supervision and guidance of the Vice President and Senior Actuary, this position will assist in the development of client annual reports, new opportunity sales proposals, and other general analysis as needed.
- For each new prospective client or clinic this position will help develop a full summary of expected clinic costs.
- In addition, the person in this role will estimate likely savings from the clinic for each client. This savings estimate will be based on a detailed understanding of the client’s health care claims cost experience and Everside Health’s ability to make an impact. The implications of this assessment will be included in initial presentations to the client.
- This position will work collaboratively with finance, sales and operations to recommend pricing that: achieves targeted levels of contribution margin, considers the client’s forecast ROI and are competitive in the marketplace.
- This position will be responsible for helping in the development of annual reports for clients, which include return on investment calculations and financial savings achieved by the clinic, as well as clinical impact and improvement, based on an analysis of actual claims experience and clinical data.
- This position will also work closely with the predictive modeling software/vendor to help focus the medical team’s efforts on targeted patients and to measure progress made.
The Actuarial Analyst responsibilities are outlined and defined below.
- Work with claims history and Everside Health clinic experience to estimate likely clinic savings
- The Actuarial Analyst will need to understand the medical claims history of each client and their performance in key categories relative to norms (primary care, urgent care, emergency rooms, etc.)
- This analysis would include the full range of medical claims and all potential segments including but not limited mental health, dental, physical therapy, etc.
- This position will recommend pricing that: achieves targeted levels of contribution, considers the client’s forecast ROI and competition
- The Actuarial Analyst will develop pricing recommendations considering company margins, client expected ROI, and market competition
- The Actuarial Analyst will deliver these recommendations to the Vice President and Senior Actuary for review
Use insights from all work to proactively identify opportunities to demonstrate value for clients and process improvements (re: clinic operations, clinical outcomes and other factors affecting ROI)
- This position has access to a wide range of important cost, benefit, and clinical information in aggregate and for each clinic.
- An important part of this position will be to use this information to proactively look for and identify opportunities for improvement.
- Analyze health care cost claims and clinic expenses to estimate total savings for clients each year
- This role will also be responsible for providing the reporting necessary for the annual reports to clients on actual claims and clinical experience.
Education, licenses, certifications, and experience required to fulfill the essential duties, include computer skills as required.
- Must have strong analytical and quantitative skills including building cost/benefit models, data mining, and the ability to summarize the implications of findings
- Strong understanding of medical diagnostic and procedure codes with the ability to organize large amounts of claims data and clinical data from the EMR using actuarially sound approaches and principles
- The person in this position will need to collaborate well on a cross-functional basis with multiple key stakeholders.
- Self-starter with the ability to streamline functions and the passion to learn and grow
- Strong financial analysis foundation creating forecasts and models
- Notable expertise with Microsoft Excel is required; familiarity with data query/data management tools extremely helpful (Access, SQL, Tableau)
- Strong communication skills and ability to work effectively cross-functionally with sales, operations, finance, etc.
- Strong financial modeling experience
- Significant experience working with healthcare claims (and EMR data) in aggregate and in organizing large amounts of raw data into meaningful categories
- Healthcare actuarial training and experience so as to be able to accurately summarize the implications of claims analytical findings and identify opportunities and risks
- The ability to work well with and proactively with cross-functional team members across the organization to gather information, request assistance when needed, and provide support when needed, etc.
- Commitment to the principles of wellness and prevention
- Strong knowledge and experience with health insurance and claims data analyses
- Strong organizational skills and ability to manage a large volume of email and telephone communication.
- Bachelor’s Degree in Accounting/Finance/Math/Actuarial/Economics
- Associateship with the Society of Actuaries preferred
PAY RANGE: $80,000-$100,000 per year