Actuary Jobs in Houston, TX

Financial Analyst II-Regulatory Reporting

Community Health Choice, Inc. (Community) is a non-profit managed care organization (MCO), licensed by the Texas Department of Insurance. Through its network of more than 10,000 providers and 94 hospitals, Community serves over 400,000 Members with the following programs:

• Medicaid State of Texas Access Reform (STAR) program for low-income children and pregnant women
• Children's Health Insurance Program (CHIP) for the children of low-income parents, which includes CHIP Perinatal benefits for unborn children of pregnant women who do not qualify for Medicaid STAR
• Health Insurance Marketplace Plans that offer individual health coverage that includes preventive care, emergency services, prescription drugs, and hospitalization available to all, regardless of pre-existing conditions.
• Community Health Choice (HMO D-SNP), a Medicare Advantage Dual Special Needs plan for people with both Medicare and Medicaid that combines Medicare Part A and Part B benefits, Medicare Part D prescription drug coverage, and Medicaid benefits with additional health benefits like dental, vision, transportation, and more.

Improving Members' experiences is at the heart of every Community position. We strive every day to make sure that our Members have access to the high-quality health care they need and deserve.

Community is accredited by URAC for its health plan operations. We offer care management programs for asthma, diabetes, and high-risk pregnancy. An affiliate of the Harris Health System (Harris Health), Community is financially self-sufficient and receives no financial support from Harris Health or from Harris County taxpayers.

JOB SUMMARY The Financial Analyst II-Regulatory Reporting leads the review, analysis, and reporting of medical claims, pharmacy, Non-Fee for Service, and Capitation Premium Revenue. Candidate must display proficiency with Microsoft Excel and Microsoft Access as well as general Health Information Management principles and experience with creating and reviewing SQL queries and extracting large amounts of data and turning it into digestible metrics. The Financial Analyst II-Regulatory Reporting duties also include routine and ad hoc reporting and database management support. This role requires an analytical mindset, great attention to detail and the ability to clearly communicate verbally and in writing outcomes from various financial analysis that will be delivered to various levels of management.

JOB SPECIFICATIONS AND CORE COMPETENCIES

• Participate in the Month End Close Process for STAR, STAR+PLUS, CHIP, CHIP Perinatal, DSNP, and Marketplace.
• Research and resolve data discrepancies.
• Review reports for accuracy.
• Participate in completion of deliverables to maintain compliance with the production of all State of Texas deliverables or other governing body in a timely manner.
• Create queries to support the needs to the business and review current queries and processes to ensure correctness and best practice creation.
• Data Maintenance, Ad-hoc analysis and reconciliation
• Respond to data requests from Community's Actuary, Auditors, HHSC Finance, and HHSC Health Plan Management.
• Stays informed on latest Federal Legislation and Regulation (e.g. HHSC, CMS, etc.
• Assist teammates and completes other duties assigned by the Director of Financial Planning & Analysis, Controller, or CFO.
• Actively contributes to achievement of departmental goals, as identified in Department's annual business plan, including specific departmental process, improvement plans, and other duties as assigned.

REPORTS TO

Position Title: Manager, State Financial Reporting

QUALIFICATIONS

Education/Specialized Training/Licensure: Bachelor's degree in finance, Accounting, Economics, Healthcare Administration, Business Administration, Computer Science or related field required.

Work Experience (Years and Area): 3+ years financial analysis required 1+ Healthcare/Managed Care preferred Management Experience (Years and Area): N/A

Software Proficiencies: Advanced proficiency in Excel, SQL Server Management Studio Relational Databases and basic knowledge of Microsoft Word, Outlook, Power Point. QNXT preferred.