Group Actuary

2 weeks ago


Sandton, South Africa Clinix Health Group (Pty) Ltd Full time

Leads the Analytics & Data Science and is responsible for evaluating complex risks, preparation of models and carries out research, commercial and business analysis, to inform the strategic decision making across the Clinix Health Group. Responsible for Data Governance across the Group. Guides the development of appropriate reports and reporting tools to guide decision making across the business. Engages in tariff negotiations with funders in support of the Funder Relations team. Evaluates Alternative Reimbursement models. Prepares Fixed Fee and other ARM proposals from time to time. Provides a monitoring function for various activities across the group including accurate clinical coding, billing, quality data collection, staffing among others.

***Minimum Qualifications and Experience**:

- Bachelor’s Degree in Mathematics, Actuarial Science, Statistics, Economics or related discipline.
- Qualified Fellow Actuary.
- Advanced Computer Skills, including understanding of SQL databases, spreadsheets and statistical analysis software.
- 5 years’ experience in healthcare financing or provision (3 years post-qualification).

***Minimum Job Requirements**:
Deep knowledge and understanding of:

- Healthcare funding models including Alternative Reimbursement models.
- Risk adjustment methodologies.
- Clinical Groupers including the diagnostic related grouper and Case Mix related concepts.
- Clinical coding including ICD-10 and CPT coding.
- Material coding including NAPPI codes, ATC codes.
- Modelling concepts including GLMs, Machine learning models.

Additional requirements:

- Ability to handle uncertainty.
- Knowledge and experience in creation of dashboards on PowerBI and similar tools.
- Good understanding of Python (NumPy, Pandas) or R.
- Advanced knowledge of Microsoft Excel.
- Excellent presentation skills and strong ability to guide decision making.

**Leadership Skills/Abilities**:

- Problem Solving, decision making, success oriented.
- Strong written and verbal communication skills.
- Strong business acumen and attention to detail.


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