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Medical Manager

Location:
Torrance, California, United States
Posted:
March 08, 2019

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Resume:

ELLENA FARAHDEL

Accomplished, Proven Actuarial Professional

Greater Los Angeles Area 310-***-****

ac8p0t@r.postjobfree.com www.linkedin.com/in/EllenaFarahdelActuary

PROFESSIONAL SUMMARY

Healthcare actuarial professional with proven history of rising in duties and responsibilities and bringing value to the company and the team.

Areas of expertise include; data analysis, data mining, reporting, product and tool development, ratemaking, pricing, product development, income and experience studies and more.

Product experience includes; PPO, HMO, pharmacy, Individual, Small Group, Large Group and Medicaid/Medicare.

Excellent communication, presentation and interpersonal skills. Work equally as well in team or individual setting.

PROFESSIONAL ACHIEVEMENTS

Actuarial A.S.A. Exams Passed: 100, 110, 120, 130, 135, 140, 150, 151,160, 161, 165 (200 Credits)

PROFESSIONAL EXPERIENCE

Anthem, Inc., Woodland Hills, CA 2017 to Present

Provider Contract/Cost of Care Consultant, Senior

Provides analytical support to the Cost of Care and/or Provider Contracting organizations.

Focuses efforts on lowering claims costs, improving the quality of care, and increasing member and provider network satisfaction.

Provides expert advice, analytic and consultative support to Medical Directors and management on cost of care issues.

Works on large-scale initiatives with high dollar cost savings opportunities.

Partners with provider contractors to develop contracting strategy and supports all aspects of the contract negotiation process.

Can work with multiple provider types, e.g. physician, ancillary, medical groups, or hospitals.

Supports a full range of contract arrangements and pricing mechanisms.

Works on complex enterprise-wide initiatives and acts as project lead.

Molina Health Care, Inc., Long Beach, CA 2004 to 2017

Director of Cost of Care Analytics 2010 to 2017

Actuarial Manager 2006 to 2010

Actuarial Associate 2004 to 2006

Accountable for enterprise-wide reporting and analysis of information to help manage the utilization, cost, and quality of health care services

Proactively mine data to identify cost drivers and collaborate with health plan management to identify root causes and to test the results of management’s effort to mitigate them

Supporting the IBNR claims estimation process

Building multiple standardized reporting templates

Developed multiple special purpose reporting tools to facilitate trend analysis and to support rate negotiations and pricing

Well Point Health Networks, Inc. Newbury Park, CA 2000 to 2004

Actuarial Analyst IV

Developed premium rates for existing individual products: PlanScape (PPO and HMO)

Developed premium rates for new individual products (PPO, short-term medical)

Performed various PPO and HMO special pricing studies for pharmacy, durational studies, member level rating

Performed various benefit design pricing and product development functions

Conducted income and experience studies

Collaborated on preparation of actuarial memoranda

Set reserves as part of IBNR process for individual, small group, and large group lines of business

Kaiser Foundation Health Plan, Inc. Pasadena, CA 1997 to 2000

Senior Actuarial Consultant

Developed pharmacy rates and performed a range of pharmacy studies

Developed rates for individual, small group and HIPC plans

Conducted various HMO pricing studies and analyses

Performed Age-Banded rates analyses

Created PPO/POS experience rating models

PRIOR ACTUARIAL EXPERIENCE

Foster Higgins & Co., Inc., Los Angeles, CA 1995 to 1997

Associate

Pricing and data for major retirement plans

Retiree medical evaluation and government filings

Data analysis, benefit calculation, and valuation

Benefit statements for major food industry and non-profit organizations

William M. Mercer, Inc., Los Angeles, CA 1994 to 1995

Actuarial Analyst

Involved in various types of HMO negotiations – Marketing, underwriting, reports, pricing, reserves, etc.

Designed and continued with ongoing development of special pricing such as self-insured PPO and HMO plans using Lotus spreadsheets and some FOX Pro programming

Health Net, Woodland Hills, CA 1992 to 1994

Actuarial Assistant

Developed special pricing such as aggregate stop loss amounts of flex funding groups, HMO, Indemnity and POS products

Designed and continued with ongoing development of alternate funding arrangements such as cash flow methodology

Provided actuarial support to underwriting and marketing

Maxicare Health Plan, Inc., Los Angeles, CA 1989 to 1992

Actuarial Analyst

Designed and derivation of complex interrelated formulae for the medical budget to accommodate pricing by group

Performed mathematical, actuarial and statistical modeling for pricing

Involved with formulation of all aspects of medical budgeting using research and analytical skills

Programmed in IFPS, Dataspan, constructed and implemented command files in 2020 and FCALC in supporting the above functions

Instructed other analysts in the use of the programs designed

Analyzed other projects for inside and outside departments

EDUCATION

Bachelor of Science. Applied Mathematics

University of California, Los Angeles

Successful completion of 11 A.S.A. actuarial examinations



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