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AVP, Actuary-Government Business

AVP, Actuary-Government Business

EmblemHealthNew York, NY, United States
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Hybrid Position

Summary of Position

  • Oversee development of pricing models and their use in product strategy for Medicare and State-Sponsored Program (SSP)

lines of business.

  • Lead Enterprise Government Actuarial Areas, which includes 400,000-500,000 lives, representing over $2.5 billion in revenue.
  • Key influencer and driver of Medicare and SSP strategy.
  • Responsible for Enterprise Medicare bid filings, Employer Group medical pricing, Medicare Supplement Pricing, SSP Premium

    • analytics, budgeting, reporting, and financial performance tracking.

  • Support risk adjustment team, including forecasting revenue, monitoring and valuing activities, and reporting.

    • Principal Accountabilities

  • Support and influence multi-year strategy development for Government business.
  • Responsible for development and accuracy of Medicare pricing / budget assumptions in support of strategy, including

    • new and existing Medicare plans.

  • Support management of segment action plans to achieve margin targets
  • Responsible for the oversight of the filing of Medicare Advantage bids.
  • Oversee development and filing of premium rates for all products with the appropriate regulatory authority (e.g.,

    • CMS, New York Department of Health).

  • Manage and develop a high-performing Actuarial team.
  • Monitor progress on individual goals, provide support on individual development plans, and proactively plan for

    • growth and succession.

  • Manage analysis of underlying business performance for Government business lines.
  • Fulfill SSP filing requirements defined by regulatory entities such as SCMS and DOH.
  • Collaborate with segment leadership, Finance, HCE, and other teams to develop accurate forecasts.
  • Design & develop standard reports to meet the needs of government programs and other leaders.
  • Key point of contact for enterprise government plan analytics.
  • Anticipate and identify key source information to analyze problems clearly, identify root causes, trends and

    • opportunities, determine creative solutions.

  • Provide Support to Medicare Product and Account Management areas through analyzing and improving financial

    • performance, including risk adjustment coding accuracy to achieve targeted profitability

    Qualifications

    Education, Training, Licenses, Certifications

  • Bachelor's degree in Actuarial Science, Mathematics, Economics, or similar major.
  • Fellow of the Society of Actuaries strongly preferred.

    • Relevant Work Experience, Knowledge, Skills, and Abilities

  • 15+ years of actuarial experience with ASA; or 12+ years' experience with FSA.
  • 10+ years health insurance actuarial experience, preferably in Medicare.
  • Ability to analyze complex health insurance issues such as risk modeling, impact of provider contracting changes, etc.
  • Strong understanding of actuarial principles & methodologies related to Medicare Advantage pricing and product design.
  • Understanding of government benefits and design.
  • Proven track record of successfully overseeing multiple large (company / divisional) projects.
  • Strong organizational skills and ability to prioritize and successfully manage multiple priorities / deadlines.
  • Strong management and leadership skills - ability to develop and motivate staff.
  • Excellent written and verbal communicator - need to be able to summarize complex analyses succinctly and be able to

    • present results to senior management and others effectively.

  • Executive presence; comfortable speaking with all organizational levels, within and external to, the company.
  • Proficient with MS Office (Word, Excel, Access, PowerPoint, Outlook).

    • Additional Information

  • Requisition ID : 1000002591
  • Hiring Range : $162,000-$302,400
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