Accounting/Finance - Director Actuarial & Analytics

JOB SUMMARY:

Directs the Data Analytics and Reporting, Actuarial, and Underwriting activities of the Company, including product and bid filing activities. Directs the development and analysis of the financial budget, with particular emphasis on premiums, medical costs and provider reimbursement plans. Directs and manages the analysis of medical, pharmacy, and other claim costs and related expenses, including utilization and other trends affecting the company. Directs and manages the estimation and reporting of the Company’s claims reserves using actuarial reserving practices. Directs the Company’s reinsurance program and manages both the broker and carrier relationships. Directs the development of special reports requested by senior management.

KEY RESPONSIBILITIES:

• Directs and manages the preparation of the annual product filings for all lines of business, including budgets, forecasts, and related analysis.


• Directs the performance and development of Underwriting, Data Analytics and Reporting, and Actuarial staff


• Directs the Underwriting Department, including rating decisions for large groups, MLR and medical cost analysis, Federal and State rate filings, and related matters. Works closely with the Marketing Department on new business and renewal proposals.


• Directs and manages the projection of claims reserves for the Company and owners’ self-funded groups, including preparation of related supporting schedules using actuarial reserving practices. Works with consulting actuary on annual reserve certification.


• Directs preparation of data for the annual Medicare and ACA Marketplace/SHOP bids. Works closely with the Companies’ consulting actuaries to develop recommended rates and ensure appropriate decisions and recommendations are in place.


• Directs the completion of special projects and reports as requested by senior management.


• Directs the financial and actuarial analysis of the Companies’ medical loss ratios and related components, including various monthly financial analyses and MD&A.


• Directs reinsurance program activities including risk analysis, claim recoveries from reinsurers, and the annual reinsurance contract review and renewal. Works closely with the Claims and Medical Management departments in the handling of high dollar members.

QUALIFICATIONS:

• Ability to apply advanced mathematical and statistical principles and techniques.


• Excellent knowledge and skills in the use of advanced spreadsheet and database applications.


• Strong knowledge and experience in the use of appropriate actuarial methods and techniques for health claim reserving.


• Successful completion of Health Care Sanctions background check.


• Ability to speak and write fluently in English.

EDUCATION/EXPERIENCE:

• Bachelor’s degree in actuarial science, math, finance, accounting, or related discipline. Graduate degree desired.


• ASA, FSA, or AAA strongly preferred.


• 10+ years of health plan experience.


• 10+ years of financial and/or actuarial analysis experience.


• 5+ years of supervisory or management experience.