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Actuarial Analyst I/II (myNEXUS)

Location: Nashville, TN
JobFamily: Actuarial
Req #: PS60695
Date Posted: Oct 25, 2021

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SHIFT: Day Job

SCHEDULE: Full-time

Your Talent. Our Vision.  At myNEXUS, a proud member of the Anthem, Inc. family of companies, it’s a powerful combination.  It’s the foundation upon which we’re creating greater access to care for our members, greater value for our customers and greater health for our communities. Join us and together we will drive the future of health care.

myNEXUS is a technology-driven, care and benefit management service that enables individuals to live healthier lives in their homes. Our proven clinical model connects individuals to intelligent care delivering independence at lower costs. To maximize health delivery, we consistently leverage our: Innovative Technologies, Advanced Clinical Expertise, and Proprietary Network Engagement Platform. We are continuously pioneering ways to optimize health resources for our clients and their customers. Through our proprietary network management and engagement programs, we realize enhancements in quality, outcomes, and care effectiveness

The myNEXUS Actuarial team is seeking an individual who is curious, creative, and assertive to lead key projects and perform complex analysis related to revenue and trend analytics. The successful candidate will collaborate with key Anthem and myNEXUS stakeholders and recommend solutions based on a deep knowledge of available authorizations, claims, provider and member data. This individual will use his or her leadership, actuarial, and analytics skills to support all customers on key projects and decisions. 

Preferred Location: Chicago, IL, or Nashville, TN

Open to other locations for the most qualified applicant

Please Note: This position may be filled at either the Actuarial Analyst II or Analyst III level.  Manager will determine level based upon the selected applicant’s skillset relative to the qualifications listed for this position.

Anthem supports a hybrid workplace model with pulse point sites used for collaboration, community, and connection. Position is currently remote until our return to office is implemented, which at that point, position will be part of our hybrid workplace model.

Job Summary:

Completes very diverse and complicated projects and performs very complex actuarial studies. This role is responsible for performing risk and health analytics that cover a broad range of providers, patients, and payers.  

This ideal candidate must have experience in healthcare trend analytics and/or statistical data analysis, and have strong SQL experience to query, maintain, and create reports across SSRS, SSMS, Tableau, RStudio, and/or other SQL related tools. The candidate must be able to assess existing data model and propose enhancements required to complete risk assessment and clinical and operational analytics. They must have the ability to quickly learn both the technology and business concepts, and experience in working with both business and IT teams. 

Primary duties may include, but are not limited to:

  • Analyzes and implements risk contracts including conducting experience analyses, pricing, filing and settlement work; and prepares management reports supporting new capitation initiatives.
  • Assists in training of actuarial trainees, analysts and specialists.
  • Coordinates/directs special actuarial projects.
  • Works with operations/finance/claims staff to strengthen existing payment integrity initiatives, analyzing utilization and cost data to develop medical cost drivers of the organization.
  • Produce monthly analysis on utilization and cost.
  • Deliver actionable insights from analysis of utilization and cost data on key medical expense drivers vs. budget and YOY trend.
  • Works with authorization data to provide regular compliance and operational analytics.
  • develops advanced analytics use cases and delivering actionable insights to all stakeholders across the company.



Actuarial Analyst II

Minimum Requirements

  • Requires a BA/BS degree (preferably in finance, mathematics, actuarial science, data science, computer science, or related field from an accredited institution).
  • Passed a minimum of three Society of Actuaries (SOA) or Casualty Actuarial Society (CAS) actuarial exams (preferably ASA or FSA).
  • Minimum of 1 year related experience; or any combination of education and experience, which would provide an equivalent background.

Actuarial Analyst I

Minimum Requirements

  • Requires a BA/BS degree (preferably in finance, mathematics, actuarial science, data science, computer science, or related field from an accredited institution).
  • Passed a minimum of one Society of Actuaries (SOA) or Casualty Actuarial Society (CAS) actuarial exam (preferably ASA or FSA); or any combination of education and experience, which would provide an equivalent background.

Preferred Qualifications (levels I/II):

  • 3+ years’ experience using Microsoft SQL Server Management Studio solutions and reporting.
  • Medicaid/Medicare provider contracting and/or risk adjustment experience.
  • Advanced understanding of Relational and Dimensional data structures and use.
  • Experience using cloud-based database platforms.
  • Experience with Agile development (SAFE or other).
  • Advanced Excel Skills- create pivot tables, v-lookups, and spreadsheets with formulas. 
  • Negotiation and persuasion skills; ability to facilitate consensus among a diverse group of stakeholders.
  • Ability to demonstrate an understanding of data structures and resolve problems.
  • Strong listening skills; ability to capture requirements expressed in design meetings.
  • Flexible and adaptable regarding learning and understanding new technologies.
  • Highly self-motivated and directed.

We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.

Anthem, Inc. has been named as a Fortune 100 Best Companies to Work For®, is ranked as one of the 2020 World’s Most Admired Companies among health insurers by Fortune magazine, and a 2020 America’s Best Employers for Diversity by Forbes. To learn more about our company and apply, please visit us at An Equal Opportunity Employer/Disability/Veteran. Anthem promotes the delivery of services in a culturally competent manner and considers cultural competency when evaluating applicants for all Anthem positions.

Please be advised that Anthem only accepts resumes from agencies that have a signed agreement with Anthem. Accordingly, Anthem is not obligated to pay referral fees to any agency that is not a party to an agreement with Anthem. Thus, any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Anthem.