Medicaid Actuarial Senior Consultant

About the role

The Deloitte Human Capital team helps organizations reimagine work, the workforce, and the workplace across the enterprise. They work with clients to transform their HR functions using AI and emerging technology. Our team within the Government and Public Services (GPS) practice serves federal, state, and local government clients, as well as public higher education institutions. We bring fresh perspectives to help clients anticipate disruption, reimagine the possible, and fulfill their mission promises.

Responsibilities

• Provide strategic and technical consulting services to public sector clients
• Support engagements focused on Medicaid reimbursement, including actuarial rate development across managed care and fee-for-service, Medicaid policy, budget forecasting and fiscal analyses, and risk adjustment
• Participate in the transformation of the health care sector through innovative actuarial solutions, such as AI-driven solutions, development of frameworks inclusive of social drivers of health, and transition of payment models to value-based payment frameworks
• Address complex, ill-defined problems with strong technical and innovative approaches
• Apply business-oriented strategies to enhance client outcomes and solutions
• Collaborate with cross-functional teams to deliver comprehensive actuarial services
• Engage in continuous learning and adaptation to emerging health care trends and technologies

Requirements

• 5+ years of health actuary experience and consulting and/or health plan/insurance company experience
• 2+ years of experience with Medicaid managed care capitation rate development and/or fee-for-service rate development
• Must be legally authorized to work in the United States without the need for employer sponsorship
• Exam progress towards ASA or FSAB
• Bachelor's Degree

Qualifications

• Preferred: ASA with progression to FSA, FSA, or career ASA designation
• Experience providing Medicaid consulting services to Government agencies
• Experience with Medicaid waivers (i.e., 1115, 1915 b/c, 1332)
• Experience with risk adjustment mechanisms
• Experience with Provider reimbursement streams (i.e., DSH, UPL, etc.)
• Experience with health care reform and working knowledge of the individual medical and small group markets
• Experience with Medicare products, including Medicare Advantage or Medicare Supplement products for various enrollee types
• Experience with reimbursement models - including value based care/ACO modeling
• Knowledge of group insurance products including disability, long term care, etc.