This position supports Emerging Markets' profitable growth and effective use of capital through analyses and reporting on risk, financial metrics, capital, reinsurance, and other topics in order to support strategic decision making. Strong analytical and communication skills are required. This role is comprised of three focus areas: capital management, corporate actuarial, and MA risk adjustment.
Medicare Advantage (MA) risk adjustment is responsible for the development and management of pricing, forecasting, and reporting architecture related to CMS risk-adjustable revenue for Medicare related products within Emerging Markets. This position designs, leads and performs advanced financial and actuarial analyses in support of department objectives, and undertakes special projects and ad hoc problem solving.
This position requires the understanding of insurance and business operations within Emerging Markets including, AF Group and COBX.
RESPONSIBILITIES/TASKS:
MA Risk Adjustment:
Calculate and forecast Medicare Advantage risk scores and revenue.
Inform MA risk adjustment team on operational metrics and provide targeting analytics to improve performance.
Develop key actuarial assumptions supporting Senior Health Services forecast and annual plan.
Complete actuarial analyses as requested to support bid pricing and accrual processes.
Analyze Medicare Advantage products and develop profitability assessments as it relates to risk adjustment.
Observe, analyze, and forecast trends.
Examine industry results and trends relative to the industry.
Monitor performance metrics and communicate to the appropriate audiences.
Perform ad hoc actuarial analyses as requested.
Experience with Medicare Advantage and/or healthcare risk adjustment is a plus but is not required.
Perform routine actuarial analyses requiring the application of acceptable actuarial techniques, procedures and criteria.
Analyze completed work for reasonableness and accuracy; utilize judgment in recommending specific courses of action considering the internal, external and customer impacts.
Learn, use and implement programming and maintain analytical programs with limited direction.
Utilize data management and structure techniques with limited direction and oversight.
Develop and enhance procedures including review for actuarial soundness.
Perform experience and financial analysis to identify root causes and develop multiple solutions for actuarial problems.
With guidance, present completed work and related implications to team members, internal clients and leadership.
Remain current on actuarial techniques, seek development and improvement opportunities and understand corporate/cross-functional objectives and cultural beliefs.
Provide commentary for various monthly scorecard reporting.
Participate in the development of new reports and tools for the department.
Monitor management reporting metrics and report on unexpected variances.
Lead meetings with business units, fostering a productive dialogue, and facilitating decisions where appropriate.
Effectively communicate drivers of results to leadership.
Analyze profitability targets for business segments and effectively communicates results and methodology to manager.
Perform cost-benefit analysis comparing results of initiatives to capital costs, considering both financial results and strategic goals.
Provide support and peer review to the pricing, reserving, and reinsurance team and the related processes.
Participate in annual planning process by assisting business segments with strategy and identifying areas for improvement.
Perform ad hoc risk projects with little direction.
Represent Corporate Risk on various corporate projects.
Work with outside actuaries and/or consultants on various projects.
Mentor and train Actuarial Interns and Actuarial Analysts.
Lead the development of new reports and tools for the department.
EDUCATION
Bachelor's degree in actuarial science, mathematics, or a related field is required. Successful completion of a minimum of four SOA examinations is required, five is preferred. Maintains membership in good standing of the Actuarial Development Program.
EXPERIENCE
A minimum of three years actuarial experience in the P&C or health insurance industry required, four preferred.
QUALIFICATIONS
Knowledge of actuarial principles and practices, underwriting and claims practices preferred.
Knowledge of mathematics and statistics with the ability to perform necessary mathematical computations.
Ability to apply the principles of logical thinking to define problems, collect data, identify trends and draw conclusions.
Excellent oral and written communications skills, with the ability to communicate actuarial concepts and conclusions to non-actuaries.
Working knowledge of Microsoft Excel.
Competent and comfortable learning and working with new software.
Maintain confidentiality as appropriate.
Ability to work both independently and as part of a team.
Comfortable leading meetings and facilitating discussion.
Ability to manage multiple priorities, establish workflows, and meet necessary deadlines.
Knowledge of actuarial principles and practices, underwriting and marketing guidelines and claims practices.
Ability to perform actuarial and statistical analyses.
Strong working knowledge of Microsoft Excel, knowledge of Igloo and R preferred, but is not required.
Some SQL, SAS, and Visual Basic knowledge preferred.
Some Tableau knowledge preferred.
Some knowledge of GAAP and SAP accounting.
Ability to create financial and actuarial models with little direction.
Ability to facilitate decisions in meetings.
Strong knowledge of GAAP and SAP accounting, including FASB accounting standards.
Ability to establish a personal rapport with opposing parties and to resolve conflicts in a professional manner.
Presentation skills and confidence to present company and product in one-on-one settings or in small groups.
Working knowledge of Microsoft PowerPoint.
Comprehends the consequences of various problem situations.
PAY RANGE:
"Actual compensation decision relies on the consideration of internal equity, candidate's skills and professional experience, geographic location, market and other potential factors. It is not standard practice for an offer to be at or near the top of the range, and therefore a reasonable estimate for this role is between $77,300 and $129,500."
The qualifications listed above are intended to represent the minimum education, experience, skills, knowledge and ability levels associated with performing the duties and responsibilities contained in this job description. We are an Equal Opportunity Employer. Diversity is valued and we will not tolerate discrimination or harassment in any form. Candidates for the position stated above are hired on an \"at will\" basis. Nothing herein is intended to create a contract.
