Senior Vice President - Health Plan Finance, Risk, and Health Management

Who We Are

For a complete understanding of this opportunity, and what will be required to be a successful applicant, read on.

WPS Health Solutions is a leading not-for-profit health insurer and federal government contractor headquartered in Wisconsin.

WPS offers health insurance plans for individuals, families, seniors, and group health plans for small to large businesses.

We process claims and provide customer support for beneficiaries of the Medicare program and manage benefits for millions of active-duty and retired military personnel across the U.

S. and abroad. WPS Health Solutions has been making health care easier for the people we serve for more than 75 years. Proud to be military and veteran ready.

Culture Drives Our Success

WPS' culture is where the great work and innovations of our people are seen, fueled, and rewarded. We accomplish this by creating an inclusive and empowering employee experience.

We recognize the benefits of Diversity, Equity, and Inclusion as an investment in our workforce - both current and future - to effectively seek, leverage, and include diverse perspectives that fuel agility and innovation on high-performing teams.

This results in people bringing their authentic selves to work every day in an organization that successfully adapts to business changes and new opportunities.

The Senior Vice President is responsible for actuarial and underwriting, network management and strategy, product management, network strategy, clinical programs, pharmacy, affordability of care, financial management, and healthcare economics.

This role will lead and drive pricing strategy and discipline, reserving in accordance with actuarial standards, healthcare reporting and analytics, ensuring health insurance products are compliant with regulatory filings, financial management across the health plan, and collaborating across the business to drive actions that mitigate claims cost.

Essential Responsibilities

• Leads the actuarial and underwriting functions, ensuring adherence to sound pricing and reserving practices - while serving as a thought partner in strategic pricing decisions, evaluating new products, and financial forecasting / budgeting.
• Creates a network management function with the disciplines and data required to effectively manage and negotiate provider contracts.
• Develops a compelling network strategy, ensuring a portfolio of best-fit networks to ensure a competitive value proposition in all geographies served.
• Utilizes expertise in analyzing claims, membership, revenue, provider behavior, member behavior, and policy / benefit design to maximize medical expense opportunities for overall improvement with a focus on the identification of key trend drivers and cost variation.
• Builds relationships with and presents information to segment leadership, clinical program leadership, and corporate actuarial and finance staff to help achieve financial growth objectives.
• Develops new innovative measures and visualization techniques that consistently turn our data into actionable insights that increase the sophistication of our information.
• Continue the momentum in rebuilding the company's clinical programs, strengthening these programs and closing capability gaps to manage risk and deliver value for our customers.
• Mitigate pharmacy cost trend through contract negotiation and implementation of innovative models while ensuring value for our members, employees, and employer groups.
• Launch an affordability of care discipline, including payment integrity, that ensures the highest degree of claims payment accuracy while continuously driving initiatives that minimize claims payment leakage.
• Lead financial management, forecasting, and budgeting activities.
• Provides ongoing management direction, feedback and coaching to staff on vision, priorities, projects, and individual performance and development.

Represents division in key corporate-wide strategic committees that influence the health insurance business direction.

Qualifications

• Bachelor's degree or equivalent combination of education and experience; Major in Statistics, Mathematics, Actuarial Science, Health Care Management, Finance, Economics; or other related fields.
• 10+ years experience in Healthcare Economics or similar experience.
• Experience working with healthcare data, both structured and unstructured including a demonstrated ability to design, evaluate and interpret complex data sets.
• Deep business acumen and fundamental understanding of the current issues and trends within the medical / commercial product space.
• Thorough understanding of product design with demonstrated product design experience.
• Demonstrated success in product development, monitoring, reporting, and quality improvement.
• Proven consumer / client centric mindset.
• Proven capabilities in strategic planning and large-scale project management including developing, planning, executing, and measuring program results.
• Demonstrated ability to develop innovative solutions through the application of advanced problem-solving skills and skilled in garnering cross-functional support as required.
• Outstanding project and resource management skills.

Education Level : Bachelor's Degree

Preferred Qualifications : MBA

Salary Range

$285,000- 325,000

The base pay offered for this position may vary within the posted range based on your job-related knowledge, skills, experience, and may fall outside of this range.

Work Location

We are a remote-first organization and offer remote work in the following approved states :

Arizona, Colorado, Connecticut, Florida, Georgia, Illinois, Indiana, Iowa, Michigan, Minnesota, Missouri, Nebraska, Nevada, New Jersey, North Carolina, North Dakota, Ohio, South Carolina, South Dakota, Texas, Virginia, Wisconsin

Remote Work Requirements

• High speed cable or fiber internet
• Minimum of 10 Mbps downstream and at least 1 Mbps upstream internet connection (can be checked at https : / / speedtest.net)
• Please review Remote Worker FAQs for additional information

Benefits

• Performance merit increase opportunities
• 401(k) with dollar-per-dollar match up to 6% of salary (100% vested immediately)
• Competitive paid time off
• Health insurance, dental insurance, and telehealth services start DAY 1
• Employee Resource Groups
• Professional and Leadership Development Programs
• Review additional benefits here

Equal Opportunity Employer / Protected Veterans / Individuals with Disabilities

The contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant.

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