Under general direction, develops and provides actuarial and financial recommendations to Senior Actuarial management that protect the organization’s financial integrity; information and recommendations provided must be sound and consistent across levels of IBNR liabilities, target pricing margins, corporate goals, new initiatives and other complex measures related to financial solvency. Drives interpretation of data and development of analytics, methods, and formulae. Mentors and trains lower level analysts. Works and consults with internal and external departments such as Rating & Underwriting, Finance, Network Management, Provider Contracting, Health Informatics, Marketing & Sales as well as BCBSA, NYSID and CMS. Ensures actuarial modeling is consistent with Standards of Practice developed and promulgated by the Actuarial Standards Board. This position is capable of handling highly complex actuarial modeling and is viewed as an expert in the field. Participates in related activities and projects as assigned.
• Represents the company in meetings and communications with NYSID, CMS, BCBSA, consultants, customers and other external parties.
• Prepares actuarial statements of opinion for filings to NYSID, CMS and the NAIC where opinions are required to be signed by a qualified, credentialed Actuary.
• Responsible for financial integrity of one or more lines of business. Recommends regional or product line profitability targets; ensures pricing is consistent with established targets for those business segments priced in actuarial.
• Initiates, plans, and manages actuarial projects relating to complex issues and trends, coordinating with several different disciplines and staff.
• Develops rates, rating factors and rate filings. Develop and maintain rating methods and models.
• Develops and maintains sound liability estimation methodologies. Recommend reserves for blocks of business and in total.
• Develops financial plans, re-forecasts and other financial projections.
• Participates in corporate or departmental projects that are generally of a non-recurring nature, often with cross-functional project participants working as a virtual team to improve the overall effectiveness of the organization. Work typically involves assessment, analysis, design, testing and implementation of new systems, policies, or standards that are critical to the competitive positioning or long-term viability of the organization.
• Provides effective technical and non-technical business advice with supporting documentation and analysis to assist management in meeting corporate goals and making strategic decisions. Involves other departmental areas as needed.
• Identifies, develops and initiates corrective action with regard to Data Warehouse integrity issues.
• Takes a leadership role as representative of the Actuarial Department on special projects involving other areas of the company. Reconciles Data Warehouse data with corporate financials.
• Develops staff and create a work environment that promotes the continual improvement of data capabilities and the quality of department analysis and reporting.
• Identifies, leads, participates in and/or implement regional or product line initiatives and/or process improvement initiatives.
• Takes a lead on consulting to various departments such as Rating & Underwriting, Healthcare Informatics, Network Management, Product Development, Provider Contracting, Corporate Communications, Financial Reporting, Compliance and others as needed on various initiatives.
• Prepares and maintains documentation related to standard operating procedures as well as routine and special projects.
• Participates in corporate or departmental process improvement initiatives that involve designing, adjusting, and documenting work processes workflow to ensure that predictable and replicable success is achieved through best practice. Adopts a whole system view in evaluating and improving the sequence and content of work activities to optimize process effectiveness and integrity.
• Consistently demonstrates high standards of integrity by supporting the Lifetime Healthcare Companies’ mission and values and adhering to the Corporate Code of Conduct.
• Maintains high regard for member privacy in accordance with the corporate privacy policies and procedures.
• Regular and reliable attendance is expected and required.
• Performs other duties as assigned by management.
• Reviews, monitors and communicates regulatory activities relating to healthcare. Leads efforts ensuring department compliance.
• Identifies emerging issues that impact corporate goals, leads resolution of issues, and recommends strategy when appropriate. Involves other functional areas as appropriate.
• Recommends, designs, and manages departmental goals consistent with corporate goals.
• Mentors and guides staff in the development of complex modeling.
• BS in Math, Economics, Actuarial Science or allied field required.
• Minimum of five years experience in health actuarial science required.
• Professional designations of Associate of the Society of Actuaries (ASA) and Member of the American Academy of Actuaries (MAAA) required.
• Ability to design and direct the creation of complex actuarial models.
• Advanced knowledge of financial and risk health arrangements.
• Strong PC skills including proficiency in Microsoft Excel, Access, Word, Power Point, Visual Basic and SAS.
• Strong verbal and written communication skills.
• Ability to design and implement process improvement.
• Strong leadership and project management skills.
• Strong leadership skills.
• Ability to translate technical concepts into business language.
• High integrity and interpersonal skills.
• High sense of urgency and accountability.
• High degree of independence, creativity and initiative.
• A thorough understanding of non-Actuarial functions such as Rating & Underwriting, Finance, Provider Contracting, Network Management, Product Development, Medical Management, Marketing & Sales, etc. and how they impact Health Plan operations, financials and forecasts must be acquired.
In addition to Level I qualifications:
• Minimum of:
• Eight years experience in health actuarial science and ASA/MAAA required or
Seven years experience and Fellowship in the Society of Actuaries (FSA.)/MAAA required.
• A thorough understanding of non-Actuarial functions such as Rating & Underwriting, Finance, Provider Contracting, Network Management, Product Development, Medical Management, Marketing & Sales, etc. and how they impact Health Plan operations, financials and forecasts.
In support of the Americans with Disabilities Act, this job description lists only those responsibilities and qualifications deemed essential to the position.
Equal Opportunity Employer
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