At-risk specialist job description

At EMC, you'll put your skills to good use as an important member of our team. You can count on gaining valuable experience while contributing to the company's success. EMC strives to hire and retain the best people by engaging, developing and rewarding employees.
Essential Functions:

Performs highly complex catastrophe modeling analysis, planning assigned catastrophe modeling workstreams and managing special projects. Utilizes catastrophe modeling software to estimate losses to the direct portfolio from pending or recent catastrophic events. Assesses financial profitability at various confidence intervals, and the impact on EMC arising from various catastrophic events. Prepares comprehensive modeling report narratives for EMC's property portfolio, as well as individual accounts, detailing the insights to statistical changes or fluctuations in the book. Prepares and reviews communication of significant changes for Actuarial, Corporate Underwriting, Corporate Risk Management, or Branch Operations. Makes recommendations based on analysis results, exposure and loss analytics, and key risk drivers, communicating them with key stakeholders. Assesses exposure data quality and accuracy, making needed corrections for analysis using catastrophe modeling software. Imports exposure data to and produces comprehensive analyses from catastrophe modeling software. Fulfills exposure and related data requests from internal departments and EMC's reinsurance broker. Supports the technical environment, including configuration and implementation of the catastrophe models, by collaborating with internal IT staff and EMC's catastrophe model vendor. Completes various data mapping requests from Actuary, Corporate Risk Management, Underwriting, Branch operations, and other internal departments. Provides expertise for cross-functional projects, including in-depth industry vertical analysis, and independent research and analysis. Serves as a subject matter expert in portfolio optimization responsible for model validation, curve fitting and portfolio roll-up and accumulation activities, including allocation of average annual loss statistics by geographical region, to ensure management has a meaningful update on the EMC property portfolio. Leads model peril research, proposes and maintains model assumptions which dictate pricing assumptions and guidelines. Publishes and presents report detailing specific metrics about EMC's property portfolio, for monitoring and strategy purposes. Peer reviews work to maintain the integrity of the actuarial work product and outlines the timeframes in which the work is completed. Provides knowledge transfer opportunities and actively supports the onboarding of team members in a mentor role. Researches and stays current with model changes. Prepares and reviews internal correspondence to internal customers which identifies impacts of model changes on EMC's current book as they occur. Proactively shares knowledge in catastrophe related areas, creating learning experiences and fostering collaboration within the department.



Education & Experience:


Bachelor's degree in actuarial science, economics, finance, mathematics, statistics, or related field or equivalent relevant experience Five years of catastrophe modeling experience, predominately in the primary property and casualty insurance environment Insurance designations preferred



Knowledge, Skills & Abilities:


Excellent knowledge of statistics and probability and computer programming, including SQL, Python, or R Strong knowledge of vendor risk assessment models, such as RMS or AIR Strong knowledge of data visualization and mapping tools, such as ArcMaps or Power BI Thorough knowledge of Microsoft Office Strong analytical, investigation and problem-solving abilities Ability to continually look for ways to improve processes and procedures Strong ability to communicate technical concepts in a non-technical manner, to a wide range of audiences Knowledge of actuarial terminology, concepts and theory preferred


Our employment practices are in accord with the laws which prohibit discrimination due to race, color, creed, sex, sexual orientation, gender identity, genetic information, religion, age, national origin or ancestry, physical or mental disability, medical condition, veteran status, active military status, citizenship status, marital status or any other consideration made unlawful by federal, state, or local laws.


All of our locations are tobacco free including in company vehicles.


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Responsible for assisting with the review, analyses, processing, and follow-up of clinical risk reports submitted through the online incident reporting system. Enhancing patient & staff safety, quality care, and minimizing loss to protect the assets of the organization. Assists with resource support to field regarding aspects of online incident reporting and processing of events. Reports to Director of Risk Operations & Business Continuity.

LHC Group is the preferred post-acute care partner for hospitals, physicians and families nationwide. From home health and hospice care to long-term acute care and community-based services, we deliver high-quality, cost-effective care that empowers patients to manage their health at home. Hospitals and health systems around the country have partnered with LHC Group to deliver patient-centered care in the home. More hospitals, physicians and families choose LHC Group, because we are united by a single, shared purpose:
It's all about helping people.



Essential Functions



Essential Functions


Responsible for assisting with the review and processing of all incoming clinical incident reports in the online incident reporting system on a daily basis. Consistently reviews, processes, & timely documents incident risk priority, risk management input fields, resolution update and event status with minimum of 95% quality completion performance per month on risk management department outcome fields. Consults with Director of Risk Operations and / or Risk Management Coordinator on questionable or complex incident issues and acts to secure answers in a timely manner. Assists with final review and closure of incoming incident files with completed manager review on a daily basis. Acts as resource to field personnel regarding aspects of incident report entry and submission. Assists with the organization and execution of home office immunization protocols and infection risk reduction protocols. Assists with the oversight and implementation of the company's drug screen program by serving as resource for drug screen protocols and required monitoring practices. Effectively controls costs through economical utilization of materials, equipment and departmental resources. Displays high standards of professional behavior and follows company code of conduct and ethics. Dresses to convey an appropriate image in accordance with organizational expectations. Conveys an impression which reflects favorably upon the public relations of the department and contributes positively to the achievement of departmental customer service goals and objectives. Assists with other risk management / infection control issues as assigned by Director of Risk Operations and / or Risk Management Coordinator within the scope of position. Any other duties as assigned.


Education & Experience



License Requirements


Current LPN licensure in state of practice.



Experience Desired


Home Health experience preferred.


Skill Requirements


Computer proficiency.



Benefits and More



Competitive Pay Flexible Schedules Paid Time Off Tuition Reimbursement Medical, dental, and vision packages 401(k) Match Program Rapid Career Advancement Opportunities Internal promotions with a career plan All-encompassing Orientation and Fast Trak option for Home Care experienced clinicians Great Culture - join our family!


Equal Opportunity Employer - vets, disability.

Must be fully vaccinated or be willing to complete full vaccination by date of hire and proof of vaccination will be required. If permitted by state law, the company will consider requests for religious or medical exemptions.

About NYC Health + Hospitals

MetroPlusHealth provides the highest quality healthcare services to residents of Bronx, Brooklyn, Manhattan, Queens and Staten Island through a comprehensive list of products, including, but not limited to, New York State Medicaid Managed Care, Medicare, Child Health Plus, Exchange, Partnership in Care, MetroPlus Gold, Essential Plan, etc. As a wholly-owned subsidiary of NYC Health + Hospitals, the largest public health system in the United States, MetroPlusHealth network includes over 27,000 primary care providers, specialists and participating clinics. For more than 30 years, MetroPlus has been committed to building strong relationships with its members and providers to enable New Yorkers to live their healthiest life.

Positon Overview

The Risk Adjustment Specialist will support a growing and critical area of our Finance Division. You will support ongoing processes and lead projects to ensure MetroPlusHealth is fully capturing data about our high-risk populations and submitting accurate information to federal and state agencies. You will work independently to monitor and support internal partners and external vendors in data collection and submission. You'll apply your problem-solving skills to resolve issues you identify. You will also calculate error and acceptance rates to track progress over time.

This opportunity is ideal for an individual interested in working at the intersection of Health Insurance Analytics and Operations, who excels at creative problem solving, is detail-oriented, and who is committed to our mission of providing access to health insurance to all New Yorkers.

Job Description

• Ongoing monitoring of data submitted by vendors to ensure project goals are being met, submitted data is complete and accurate, and errors are identified quickly.
• Proactively work with external and internal partners to resolve issues - this includes identifying the root cause, devising plans to remediate, and ensuring on-time completion from all stakeholders.
• Monitor submission reports for Risk Adjustment and Encounters data in all lines of business, including Medicaid, Medicare and Affordable Care Act/Commercial. This includes calculating the number of encounters accepted and rejected in all lines of business.
• Calculate the financial impact of Risk Adjustment activities, including the impact to revenue of resolving errors.
• Access our Data Warehouse to conduct in-depth analysis of our member and provider claims and enrollment data.
• Utilize dashboards to identify trends and potential opportunities in data collection and reporting.

Minimum Qualifications

• Bachelor's degree, with a demonstrated interest in Finance, Social Services or Health Care.
• 1-2 years' experience working for a Health Plan, or in a Finance, Project Management or Actuarial capacity in another industry.
• Ability to work independently to investigate, pinpoint, and resolve problems.
• Strong analytical and financial skills.
• Proactive communication style and ability to work with a variety of stakeholders to achieve project goals.

Professional Compentencies

• Integrity and Trust

• Customer Focus

• Functional/Technical skills

• Written/Oral Communication