What is a Healthcare Actuary?

A health care actuary is a professional who uses their math and statistical skills to perform various health care data analyses. They provide information to health care leaders who use it to reduce the risks associated with health care access, quality, delivery and financing. Health care actuaries are usually asked to perform research regarding proposed new financing or delivery options, such as new mental health services or risk-sharing arrangements.

Job Duties

Health care actuaries prepare rate files, review plan reserves and analyze medical trends for new risks and opportunities. They create monthly reports from aggregate health plan data that is collected from national databases. Health care actuaries collect, analyze and summarize health plan experiences and account information in order to prepare special financial reports. They also study existing and emerging legislation in order to propose better adherence guidelines.

Health care actuaries file financial reports and advise management on the actions needed to comply with state and federal legal requirements. They analyze financial and accounting databases in order to prepare financial forecasts and strategic plans. They help management with training and supervising staff who collect, process and manage files and data. They provide educational growth opportunities to develop staff’s understanding of health care data analytics.

Required Skills and Knowledge

Health care actuaries will need at least five years’ experience in the field of health care. Most employers prefer candidates who have experience in managed care, carrier environments, health informatics and medical-based accounting. Any kind of accounting experience is required, because health care actuaries must interpret patient, hospital and insurance company financial statements. Experience working in a heavily regulated environment while interacting with state and federal government agencies is preferred.

Health care actuaries need to have strong computer skills with working knowledge of data flow, analytics, warehouses and manipulation. Employers will expect candidates to have experience with state and federal health care markets. Health care actuaries need to maintain a working knowledge of Medicare, Medicaid and commercial insurance products. They will need technical proficiency in health care actuarial standards of practice.

Actuarial Science Degree

Actuaries must have a bachelor’s degree in math, statistics or actuarial science. The latter is a discipline that uses mathematical models, economic concepts and statistical tools to solve problems in finance and insurance. These programs provide students with opportunities to acquire the quantitative skills and business acumen needed for a career in financial and insurance analysis. Some programs allow students to specialize in home, vehicle or health care insurance, according to the Society of Actuaries.

Students take classes in accounting, business law, professional communication and introductory macroeconomics and microeconomics. They also study the principles of business finance, industry ethical issues, information systems management and algebra with calculus. Students also are introduced to business statistics, enterprise applications, database administration and risk management principles.

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Health care actuaries also work for insurance companies performing the development, implementation and monitoring of insurance analysis and risk prediction projects. They will focus on trend analysis, benefit pricing, rate factor development and rating formula maintenance.