This job is an ASA Certified actuary position that initiates and leads development of advanced actuarial models and analyses specifically focused on forecasting Medicare Advantage Star Ratings. The incumbent will also apply actuarial techniques and statistical analysis in the development and evaluation clinical quality improvement initiatives utilizing a variety of healthcare data sources including claims, enrollment, clinical, HEDIS, and CMS data. Outline data requirements for a study or analysis and devise insightful and creative solutions.

Consider alternate explanations or viewpoints before drawing conclusions. Initiate and lead the development of studies, analyses, and presentation materials needed to appropriately inform decision makers. Use advanced industry knowledge to both perform reasonability checks as well as exceed customer expectations.

Identify methods to test whether suspect results are correct. Form reasonable approximations in advance of results of an analysis and determine whether deviations are reasonable or suspect. Demonstrate subject matter expertise and as a result is sought out by others for technical input on producing accurate and efficient work.

Exhibit a thorough understanding of both corporate and division goals and values. Apply corporate, qualified, and industry knowledge & insight to all tasks under incumbent’s control or influence. Use expertise to envision and implement innovative new processes and propose changes to existing processes, leading to improved outcomes that better conform to corporate goals, objectives, and values.

Demonstrate a capacity to shift between “big picture” and “detailed” thinking when analyzing issues and their strategic importance. Independently manage own time and resources across many projects. Demonstrate responsiveness, confidence,



flexibility and ability to independently prioritize when shifting from one task to another.

Identify emerging opportunities, establish project objectives, specify strategies, and organize necessary tasks. Enhance department influence by providing responsive service and understanding customer needs. Listen, take direction, accept criticism and feedback and adjust behavior accordingly to improve performance.

Demonstrate flexibility and proactively take on additional work as needed by the team, leading by example. Bachelor’s Degree in Actuarial Science, Mathematics, Statistics or closely related field Associate of the Society of Actuaries (ASA) Fellow of the Society of Actuaries (FSA) Possesses and applies a comprehensive and in-depth knowledge of actuarial principles, concepts, practices and processes within multiple fields or disciplines Develops, designs, and tests analytic frameworks to solve complex problems using innovative approaches Language (Other than English): Travel Requirement: Office-based Travel regularly from the office to various work sites or from site-to-site Works primarily out-of-the office selling products/services (sales employees) Physical work site required Position self or move lower on ground, under tables/desks, etc. Use Hands/Fingers to Handle or Feel (beyond just data entry) It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job.

Compliance Requirement:



This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies. As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company’s Handbook of Privacy Policies and Practices and Information Security Policy.

This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements.

Highmark

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📌 Actuary - Medicare Stars and Quality (Winnipeg)
🏢 Highmark Health
📍 Winnipeg