ESSENTIAL EDUCATION AND EXPERIENCE: Bachelor's degree in Actuarial Science, Mathematics, Statistics, Finance, or a related field, and Associate or Fellow preferred (e.g., ASA, FSA, MAAA). We require 7+ years of actuarial experience in pricing, risk assessment, portfolio management and financial analysis within the insurance industry.
SKILLS/COMPETENCIES REQUIREMENTS:
- Strong analytical and quantitative skills, with the ability to apply actuarial theory to real-world business scenarios.
- Excellent problem-solving abilities and attention to detail.
- Advanced proficiency in actuarial and statistical modeling tools (e.g., Excel, R, SAS, Python, Power BI, Tableau).
- Knowledge of healthcare claims data and the dynamics of health insurance products, PBM's, TPA's, medical cost containment strategies and Point Solutions.
- Effective communication skills, with the ability to present complex concepts to non-technical stakeholders.
- Ability to work collaboratively in a cross-functional environment and provide clear insights to drive business decisions.
- Sound understanding of regulatory requirements and industry standards related to medical stop loss insurance.
- Experience in medical stop loss insurance or health insurance industry is highly preferred.
- Proficiency in actuarial modeling techniques, statistical analysis, predictive modeling and stop loss portfolio management is highly preferred.
- Strong experience with actuarial software and data analysis tools (e.g., Excel, SAS, R, SQL, or similar platforms).
ESSENTIAL DUTIES AND RESPONSIBILITIES:
- Develop and maintain actuarial pricing models for medical stop loss insurance, including the use of experience-rated and fully insured approaches.
- Utilize advanced statistical and actuarial techniques to analyze claims data, healthcare trends, and other relevant factors to set appropriate premiums and risk shares.
- Perform experience analysis on in-force business, including loss ratio analysis, trend analysis, and predictive modeling to identify opportunities for rate adjustments or product enhancements.
- Provide pricing recommendations for new business, renewals, and amendments, based on a thorough understanding of the risk profile and market conditions.
- Collaborate with underwriting and sales teams to adjust rates for individual clients based on their specific risk factors, claims history, and risk mitigation.
- Evaluate pricing and underwriting assumptions, including claim frequency, severity, operating and ceding expenses, to ensure that premiums are competitive, adequate, and aligned with company and captive profitability and growth targets.
- Leverage data analytics tools to collect, manage, and analyze large datasets, ensuring that models are built on accurate and up-to-date data.
- Collaborate and lead as necessary, data analysis and modeling within CRI Health Solutions to support projects and planning.
- Continuously evaluate and implement innovative technologies or methodologies to improve pricing accuracy and operational efficiency.
- Perform experience analysis on in-force business, including loss ratio analysis, trend analysis, and predictive modeling to identify opportunities for rate adjustments or product enhancements.
- Provide pricing recommendations for new business, renewals, and amendments, based on a thorough understanding of the risk profile and market conditions.
- Collaborate with underwriting and sales teams to adjust rates for individual clients based on their specific risk factors, claims history, and risk mitigation measures.
- Monitor the overall profitability of the medical stop loss portfolio, including analyzing loss ratios, claims trends, and other key performance indicators (KPIs).
- Collaborate closely with teams to ensure that pricing assumptions are aligned with actual claims experience and overall portfolio performance.
- Develop and present pricing strategies to ensure alignment with goals and risk tolerance.
- Collaborate with cross-functional teams, including underwriting, sales, product development, and finance, to ensure that strategies and assumptions align with broader business objectives.
- Communicate complex actuarial concepts and pricing recommendations clearly to non-actuarial stakeholders in a way that is understandable and actionable.
- Provide actuarial expertise and insights during meetings with brokers, clients, and consultants.
TRAVEL: Frequent