Manager - Actuarial Processes

Overview
In this role, you will be responsible for performing a full scope of actuarial and statistical analyses to support both internal and external customers across different lines of business, including Medicare, Medicaid, Commercial, Value-Based Care (VBC), and more. You will collaborate with upper management and other business units, leveraging strong analytical skills and sound judgment to make decisions based on available information. The position also involves contributing to the development of process improvements within the department.

Key Responsibilities

• Lead meetings with business partners across multiple lines of business (Medicare, Medicaid, Commercial, VBC, etc.) to understand the nature of the business and gather input on specific drivers of analysis.

• Drive results discussions and maintain ongoing communication with stakeholders across different lines of business.

• Collaborate with Finance and Accounting to provide timely and accurate financial and actuarial reports for various financial statement items.

• Oversee the preparation of data and analyses for regulatory reporting and audits.

• Provide essential data for rate filings and support new product development analyses across various lines of business.

• Analyze data to support physician and vendor arrangements, and assist with reporting related to regulatory requirements such as MLR filings.

• Lead the development of ad hoc reports to supplement routine management reports through query building and data extraction.

• Implement process improvements and automation within the department.

• Ensure the integrity of data used for actuarial and statistical analysis.

• Share knowledge and mentor team members, promoting collaboration and continuous learning.

• Assist in developing actuarial analyses for complex issues and trends, drawing conclusions from diverse sources of data.

• Represent the Actuarial Department on special projects involving other areas of the company or external constituents.

• Analyze the impact of regulatory changes on health plans and develop impact analyses.

• Perform reconciliations related to vendor contracts as needed.

Qualifications

• Bachelor's degree in Mathematics, Statistics, Actuarial Sciences, or a related field (Master's degree preferred).

• Completion of Society of Actuaries exam(s) preferred.

• Minimum of five (5) years of experience in Actuarial, Underwriting, or Statistical Analysis, with health care experience preferred.

• ASA or FSA designation preferred.

• At least two (2) years of progressive leadership or management experience.

• Proven ability to manage complex projects and lead teams across multiple lines of business.

• Strong problem-solving skills and the ability to analyze complex data.

• Excellent written and verbal communication skills.

• Self-motivated with the ability to perform under pressure in a fast-paced environment.

• Strong interpersonal and organizational skills, with the ability to prioritize and multitask.

• In-depth understanding of non-actuarial functions such as Provider Contracting, Network Management, Product Development, and Medical Management.

• Advanced proficiency in Excel, Access, and other analytic or query tools is preferred.

• Proven track record of demonstrating organizational values such as Passion, Caring, Respect, Trust, Collaboration, and Accountability.

Essential Accountabilities

• Collaborate with business units across Medicare, Medicaid, Commercial, and VBC lines of business to understand business needs and drive meaningful analyses.

• Prepare and deliver financial and actuarial reports on time and accurately across various lines of business.

• Lead efforts to ensure data integrity and transparency.

• Provide key insights for regulatory compliance and audits across different business units.

• Support the development of new product offerings and rate filings across Medicare, Medicaid, Commercial, and VBC.

• Lead the automation and process improvements within the actuarial function.

Please send your resume !