Leads a team of analysts and actuaries to provide timely, accurate, actionable data and analysis supporting the department, area, and corporate key initiatives. Participate as a key strategic member of Senior Management. Provide analytics for strategic and operating decisions to senior management. Provide proactive analysis and recommendations to senior management on both tactical and strategic nature. Develop and maintain relationships, and act as primary point of contact with external actuarial consultants.
Manage the monthly calculation of the Corporation’s IBNR reserves.
Assist with development annual Medicare filings and Medicaid state rate filings, including all managerial review and certification if necessary.
Manage and develop actionable recommendations to management relative to all analysis.
Manage and perform monthly analysis identifying opportunities to reduce cost and utilization and provide recommendations to senior management.
Manage and supervise cross-functional teams to address key issues facing the organization.
Evaluate and assess the government reimbursement process to determine areas of risk and opportunity.
Oversee regional initiatives to improve operating results.
Lead, initiate, and develop key analysis to improve overall MLR results.
Develop and maintain relationships with and work closely with outside consultants and senior management to ensure that projects conform to Actuarial Standards of Practice.
Manage the monitoring of trends and changes in the actuarial field and healthcare industry and communicate findings to upper management and appropriate associates.
Maintain necessary continuing education requirements as required by the Society of Actuaries.
Additional duties as assigned.
Advises senior management in long-range planning.
Provides technical direction to functional managers, other directors, and management.
Recommends changes in area(s) policy and procedure.
Ability to travel by automobile, plane or other public transportation as necessary.
Required Other Bachelor's degree from four-year college or university or a Graduate degree
Required Other Certification as a Fellow of the Society of Actuaries and four or more years of significant health plan experience, or certification as an Associate of the Society of Actuaries and six or more years of significant health plan experience
Intermediate Demonstrated interpersonal/verbal communication skills
Intermediate Demonstrated written communication skills
Intermediate Ability to lead/manage others
Advanced Demonstrated analytical skills
Intermediate Ability to work in a fast paced environment with changing priorities
Intermediate Demonstrated organizational skills
Intermediate Other Needs to articulate ideas and recommendations in a concise and actionable presentation
Intermediate Other Ability to effectively communicate clearly and grammatically both complex and simple messages to all levels within or outside the organization
Advanced Other Ability to define problems, collect data, establish facts, and draw valid conclusions
Advanced Other Ability to interpret an extensive variety of technical instructions in mathematical or diagram form and deal with several abstract and concrete variables
Intermediate Other Ability to remain calm under pressure
Intermediate Other Strategic decision making abilities
Licenses and Certifications:A license in one of the following is required:Technical Skills:Languages: