UPMC Health Plan's growing Actuary department is seeking a Director, Actuary to ensure that the UPMC Health Plan Actuarial Department provides the following services to various in-house clients.
Responsibilities:
- Consultant within UPMC Health System; Act as an Actuarial Consultant within the UPMC Health System and perform various activities, Including IBNR calculations, Data Analysis.
- Ensure that the departmental work products meet the highest standards of quality.
- Reserving: Works with the financial reporting department to develop reserve amounts for IBNR claims, active claims and premium deficiency reserves on a regular or as-needed basis.
- Benefits and Product Development: To provide appropriate UPMC management personnel with actuarial valuations of the Impact of any proposed benefit changes or new product designs on an as-needed basis.
- Underwriting: Works closely with the underwriting department to: Provide pricing tools to enable underwriting personnel to produce accurate price quotes on request from Sales and Marketing staff in a timely basis, together with whatever appropriate supportive documents may be needed by sales staff to facilitate sales.
- Provider Relations/contracting: To provide reports for the purpose of evaluating and advising UPMC HP management on the financial impact of proposed provider agreements or changes to existing agreements on an as-needed basis.
- Manage Actuarial Department: Supervise Actuarial department and various entities within UPMC Health Plan as needed to ensure department goals and objectives are met.
- Pricing: To develop product pricing levels, factors and methods to ensure premium and revenue flow adequate to cover medical and administrative costs and profit margins for the various product lines consistent with corporate strategic goals. Also, to advise UPMC Health Plan senior management on the financial impact of any special pricing or contract arrangements which may affect health plan financial profitability.
- Work with the UPMC HP Appointed Actuary to ensure satisfactory filings of annual Statements of Actuarial Opinion and associated memoranda.
- Direct the development and assessment of underwriting methods and tools in order to enhance the ability of underwriting staff to accurately identity and quantify risk, and so produce price quotes which appropriately match premium to risk.
- Supervise Actuarial department personnel to ensure that departmental objective and goals are achieved in a timely manner
- Forecasting: To provide UPMC HP senior management with regular and ad hoc reports which communicate current and future near- and long-term projections of financial performance of the various health product lines in order to facilitate corporate decision and the development of corporate strategies and goals.
- Compliance: Ensure that all required statutory rate filings are submitted appropriately, and that all rates, factors and methods are in compliance with applicable state and federal regulations. Ascertain and comply with filing and actuarial requirements for participation in government-sponsored health plans as appropriate.
- Additional Business: Ability to learn new lines of business to help UPMC Health Systems to expand into different arenas such as Slop Loss Insurance or Workers Compensation.
Qualifications:
- Minimum Bachelor's degree in mathematics, statistics, actuarial science, economics or related field.
- Advanced degree preferred.
- 8 plus years of experience in progressively more responsible actuarial work in health insurance/managed care or equivalent training/education.
- Experience with both commercial and government health programs preferred, specific involvement with the new MMA regulation, in-depth understanding of health insurance market dynamics.
- Excellent problem solving and analytical skills.
- Good oral and written communication skills.
- Strong PC skills.
- Data retrieval skills and relational database experience.
Licensure, Certifications, and Clearances: - ASA or FAS certification by Society of Actuaries required.
- Membership in the American Academy of Actuaries required.
- ASA or FSA certification by Society of Actuaries required. Membership in the American Academy of Actuaries required.
- Act 34
UPMC is an Equal Opportunity Employer/Disability/Veteran
Working at
UPMC Senior Communities
UPMC Senior Communities is a reputable and leading provider of senior living and healthcare services. With a strong commitment to exceptional care, UPMC Senior Communities offers a range of options including independent living, assisted living, and memory care. As an actuary at UPMC Senior Communities, you'll be part of a dedicated team that plays a crucial role in managing risks and ensuring the financial stability of the organization. Actuaries utilize their expertise in statistical modeling, data analysis, and risk assessment to evaluate risks, develop pricing strategies, and provide insights that support evidence-based decision-making. Collaborating with cross-functional teams, actuaries at UPMC Senior Communities contribute their analytical skills to optimize financial resources, forecast trends, and develop strategies that enhance the financial health of the organization. Actuaries analyze complex data sets, assess risks, and provide recommendations that help in providing quality care to seniors while maintaining a sustainable financial model. UPMC Senior Communities values professional growth and offers ongoing training and development opportunities for actuaries. Actuaries have the chance to enhance their skills, stay up to date with industry advancements, and contribute to the success of providing exceptional care to seniors. Join UPMC Senior Communities' esteemed actuarial team and embark on a rewarding career where you can apply your actuarial expertise, make a meaningful impact on the lives of seniors, and enjoy competitive benefits in a supportive and compassionate work environment.