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Fallon Health Actuarial Analysts - Junior and Senior Levels! Growing Health Org! in Worcester, Massachusetts


Our Actuarial Services function is growing and we are looking for people at both junior and senior levels!

About Fallon Health

Founded in 1977, Fallon Health is a leading health care services organization that supports the diverse and changing needs of those we serve. In addition to offering innovative health insurance solutions and a variety of Medicaid and Medicare products, we excel in creating unique health care programs and services that provide coordinated, integrated care for seniors and individuals with complex health needs. Fallon has consistently ranked among the nation’s top health plans, and is accredited by the National Committee for Quality Assurance for its HMO, Medicare Advantage and Medicaid products. For more information, visit fallonhealth.org.

The following is just a broad overview of the experience so we would love to hear from you whether yo are still early in your career or a seasoned experienced Actuarial expert - we'll find a spot for you on our team!

Position Overview:

Fallon Healths product and service offerings are more diverse than any of our competitors and that means you'll enjoy working with a broad range of offerings. Also, unlike other health insurance companies, you will have exposure across all lines of business and people at all levels of the organization. That means great opportunity for advancement and work satisfaction as you're involved in a broad range projects and initiatives!

In either the junior or senior role you will be responsible for extracting, analyzing, and modeling health-care data to develop financial reports to support various product lines. This position will also develop a strong working knowledge of the forecasting/budgeting reports. A thorough understanding of Fallon’s products, revenue streams, data warehouse, business partners, providers, risk arrangements and regulatory agencies will be necessary to provide timely and accurate information to the business areas we support to execute our corporate strategy.

You will also be responsible for data quality and data integrity as they relate to reporting and analysis activities. This position will also work with the product line management, Medical Economics, NDM, and Accounting to provide analysis on product performance.

In addition, you'll participate in corporate project work-groups and team initiatives as assigned. The position will also be responsible for the direction and completion of other projects, data oversight and analyses as needed to solve business problems and improve business processes.


Financial Reporting

  • Extract data and produce historical financial reports.

  • Support the monthly close process as needed. This may involve calculating accruals to support Accounting on Revenue and Medical expense figures.

  • Provide actionable analyses and reports that help monitor line of business performance and drive decision making to reduce total medical expense and maximize revenue

  • Perform data mining to discover patterns and relationship, present to Senior Management or respective committee


  • Analyzes financial and statistical data (and other information as required) in support of creating the annual budget and rolling quarterly forecast.

Product Line support

  • Prepare reports and supporting analysis for internal and external stakeholders

  • Meet regularly with the product line manager to identify and implement reports to improve product performance and identify opportunities to enhance revenue

  • Represent the department in various standing meetings including but not limited to product line performance meetings, Financial close meetings, and Compliance meetings.

Encounter Data

  • Supports encounter data efforts (CMS EDPS, APCD, Medicaid, Navicare). Interact with Claims Department, IT, Provider Relations, NDM, and QXNT Configuration as necessary in order to ensure optimum data throughput.


  • Experience in managed health care financial analysis. Familiarity with Medicare Advantage and/or MassHealth is a plus.

  • Support role: Actuarial, Finance, Accounting, Regulatory, Enrollment, Claims – other

  • Advanced Excel skills

  • SQL- Navigator and/or Alteryx experience

  • Ability to work independently with strong analytical skills and attention to detail.

  • Ability to communicate effectively and in a professional manner in both written and verbal form.

  • BA or BS – Mathematics, Finance, Economics, Management, other


Location US-MA-Worcester

Posted Date 1 month ago (12/10/2019 12:00 PM)

Job ID 5835

# Positions 1

Category Finance