The Senior Director of Actuarial Services will oversee the actuarial functions for all health insurance plans administered by the company, ensuring compliance, accuracy, and performance optimization. This key leadership role is responsible for managing actuarial analysis for underwriting and pricing, and contributing to strategic decision-making for risk management, pricing models, and benefits design.
Duties and Responsibilities:
- Oversee and perform complex actuarial analyses related to pricing, forecasting, trend analysis, risk management, and performance measurement for healthcare insurance plans.
- Develop and maintain pricing models, underwriting guidelines, and methodologies to ensure the financial sustainability of health plans. Provide pricing recommendations based on actuarial analysis.
- Analyze healthcare trends, utilization rates, medical costs and collaborate with financial teams to align on inputs and assumptions like trend, program changes, population changes to forecast medical expense at a detailed level
- Evaluate and model risk associated with claims data, including medical, pharmacy, and behavioral health costs.
- Monitor key performance indicators (KPIs) and adjust pricing models to align with changing market conditions.
- Conduct sensitivity analysis and stress testing to assess potential financial impacts of changes in the healthcare environment.
- Analyze large datasets to identify trends, assess risk, and ensure accurate pricing and reserve levels.
- Utilize data analytics and actuarial software to create detailed reports, presenting findings to clients, and external auditors. Interpret and communicate complex actuarial data in an understandable way for non-technical audiences.
- Ensure compliance with state and federal regulations, including healthcare legislation changes by maintaining up-to-date knowledge of regulatory changes.
- Assist in the preparation and filing of required actuarial reports with regulatory bodies (e.g., state insurance departments, CMS).
- Support regulatory filings related to rate changes, risk adjustment, solvency, and other required actuarial reports.
- Provide actuarial analysis and documentation in response to regulatory inquiries and audits.
- Assess historical claims experience to forecast future claims costs and establish reserves.
- Monitor claims development, identify emerging trends, and provide recommendations for improvements or adjustments to claims management strategies.
- Work closely with other departments, including underwriting, claims, and legal, to ensure actuarial assumptions align with company strategy and regulatory requirements.
- Contribute to the company's strategic initiatives related to cost containment, provider network management, and value-based care.
- Review and validate actuarial assumptions and methodologies used in filings, ensuring accuracy and transparency in regulatory reporting.
Requirements
Pay may vary based on location. Offers will be adjusted based on an individual's experience, education, certifications and other job-related factors as permitted by law. Pay range is $150,000-$220,000 per year.
Required Knowledge, Skills, and Abilities:
- Bachelor degree in Actuarial Science, Mathematics, Statistics, or related field or equivalent experience. Graduate level degree preferred
- FSA (Fellow of the Society of Actuaries) required, Member of American Academy of Actuaries Certification preferred.
- 7+ years of experience in an actuarial role, with a focus on medical insurance or healthcare-related actuarial work.
- Five years of experience in a leadership role in a healthcare industry where HIPPAA and HITECH standards are utilized
- Experience in pricing, forecasting, and risk management within the health insurance industry.
- Familiarity with healthcare data analytics, claims data, and healthcare trends.
- Experience with regulatory reporting and compliance, including filings with state insurance departments and federal agencies.
- Proficiency in actuarial software (e.g., SAS, R, SQL, Excel, Prophet, or similar tools).
- Strong analytical and quantitative skills, with the ability to interpret complex data and generate actionable insights.
- Excellent communication skills, both written and verbal, with the ability to present technical concepts to non-technical audiences.
- Strong attention to detail and ability to work under pressure and meet deadlines.
- Knowledge of healthcare regulations and the ability to stay current with evolving regulatory requirements.
- Experience with healthcare reform regulations (e.g., Affordable Care Act, Medicaid, Medicare).
- Familiarity with the regulatory reporting requirements specific to the medical insurance industry, including rate filings, risk adjustment, and solvency regulations.
- Experience with healthcare provider networks, value-based care models, or other alternative payment models.
- Solid working knowledge of standard computer applications including MS Word, Excel, Outlook, and PowerPoint
- Ability using a computer which includes expert keyboard and navigation skills and learning new programs
- Communicate clearly and professionally with internal and external customers
- Work effectively individually and as part of a team to achieve established outcomes. Understand other's roles and empower one another to take responsibility to be successful.
- Demonstrate collaborative interactions with peers to reach a common goal as well as be a resource to team members and internal/external customers
- Pay close attention to detail in all aspects of the job
- Make decisions using available resources and sound judgment
- Maintain confidentiality and discretion
- Identify and resolve problems in a timely manner, gather and analyzes information skillfully and proactively
- Teach, coach, and counsel associates by effectively communicating and providing follow-up.
- Open to other's ideas and exhibits a willingness to try new things.
- Demonstrate accuracy and thoroughness; monitor work to ensure quality.
- Prioritize and plan work activities to use time efficiently.
- Adapt to changes in the work environment, manage competing demands and is able to deal with frequent change, delays, or unexpected events.
- Follows instructions, responds to direction, and solicits feedback to improve.
Physical Demands: The physical demands described here are representative of those necessary for an employee to successfully perform the essential functions of this job. Reasonable accommodation can be made to enable individuals with disabilities to perform the essential functions.
- Constant: Talk, hear, speak, and use hands and fingers to operate a computer, telephone, keyboard/mouse; occasionally move about the office
- Constant: Specific vision abilities required by this job include close vision requirements due to computer work for full shift
- Occasional: Lift and/or move up to 10 pounds
- Constant: Regular, predictable attendance is required
- Constant: While performing the duties of this job, the employee is regularly sitting for the full shift.
Work Environment: The work environment described is representative of what must be met by an employee successfully to perform the essential functions of this job.
- The physical environment is indoors in a controlled climate, office setting. The noise level may be low to moderate.
The duties described are representative, but not restrictive of tasks that may be assigned or of the abilities required to do the job. The description is subject to change at any time. Other related duties may be assigned. This description does not alter the at-will status of employment