Medical Claims FP&A Senior Manager

The Medical Claims FP&A Senior Manager will manage projection and results analysis for core Medicare Advantage Part C medical claims expense processed and paid on a fee-for-service (FFS) basis.

They will manage a small team of direct reports responsible for: (a) completing a quarterly GAAP financial projection for these expenses, (b) reviewing and explaining monthly actual results relative to projection, and (c) working internally and cross-functionally to enhance the granularity and decision-making influence of the projection and analysis process.

Model enhancement and greater integration with matrix teams under responsibility (c) is expected to be the largest focus for the manager in the medium and long term.

This individual will work with various teams including, but not limited to FP&A centralization, Market Finance, Product, Pricing, Reserving, Operations, and external Audit Firms.

Given the close partnership between this team and the Actuarial Pricing and Reserving teams, an actuarial background and SOA credential (ASA or FSA) is strongly preferred but not required (otherwise, familiarity with forecasting and reserving is a must).

Responsibilities


* Review and approve proposed fee-for-service (FFS) medical expense projections.

Challenge assumptions where appropriate and request adequate support.


* Explain both proposed projections and results relative to expectations to senior leadership.

Provide insights on actionable takeaways.


* Guide the team on appropriate prioritization of model development/enhancement and completion of core deliverables around monthly financial close or quarterly projection refresh.


* Consider and implement ways to improve accuracy, completeness, granularity, or efficiency in calculating fee-for-service (FFS) liabilities.


* Collaborate with Contracting/Medical Economics/Clinical/etc.

teams to improve the operational/clinical relevance and actionability of the projection and results analysis work.


* Help ensure that all reporting and results are provided in a timely and well-structured manner to stakeholders including the Enterprise FP&A team and Accounting team.

Qualifications and Competencies


* Bachelor's degree in Finance, Analytics, Health Information Management, Management Information Systems, Economics, or related field strongly preferred


* 5+ years of experience with complex model/data governance (primarily in Excel/SQL).

Familiarity with R/Python a plus.


* Experience with medical claims, clinical, and financial data


* An actuarial background and SOA credential (ASA or FSA) is preferred but not required (otherwise, familiarity with forecasting and reserving is needed).


* Familiarity with model principles for financial projection, actual-to-expected analysis, and ideally short duration financial reserves.


* Experience organizing best practices for automated workflow development, ensuring consistency in documentation and coding styles across a team ...