AVP, Actuary-Government Business - New York - EmblemHealth

    EmblemHealth
    EmblemHealth New York

    16 hours ago

    Description
    Hybrid Position

    Summary of Position


    • Oversee development of pricing models and their use in product strategy for Medicare and State-Sponsored Program (SSP)
    lines of business.

    • Lead Enterprise Government Actuarial Areas, which includes 400,000-500,000 lives, representing over $2.5 billion in revenue.
    • Key influencer and driver of Medicare and SSP strategy.
    • Responsible for Enterprise Medicare bid filings, Employer Group medical pricing, Medicare Supplement Pricing, SSP Premium
    analytics, budgeting, reporting, and financial performance tracking.

    • Support risk adjustment team, including forecasting revenue, monitoring and valuing activities, and reporting.
    Principal Accountabilities


    • Support and influence multi-year strategy development for Government business.
    • Responsible for development and accuracy of Medicare pricing/budget assumptions in support of strategy, including
    new and existing Medicare plans.

    • Support management of segment action plans to achieve margin targets
    • Responsible for the oversight of the filing of Medicare Advantage bids.
    • Oversee development and filing of premium rates for all products with the appropriate regulatory authority (e.g.,
    CMS, New York Department of Health).

    • Manage and develop a high-performing Actuarial team.
    • Monitor progress on individual goals, provide support on individual development plans, and proactively plan for
    growth and succession.

    • Manage analysis of underlying business performance for Government business lines.
    • Fulfill SSP filing requirements defined by regulatory entities such as SCMS and DOH.
    • Collaborate with segment leadership, Finance, HCE, and other teams to develop accurate forecasts.
    • Design & develop standard reports to meet the needs of government programs and other leaders.
    • Key point of contact for enterprise government plan analytics.
    • Anticipate and identify key source information to analyze problems clearly, identify root causes, trends and
    opportunities, determine creative solutions.

    • Provide Support to Medicare Product and Account Management areas through analyzing and improving financial
    performance, including risk adjustment coding accuracy to achieve targeted profitability

    Qualifications
    Education, Training, Licenses, Certifications


    • Bachelor's degree in Actuarial Science, Mathematics, Economics, or similar major.
    • Fellow of the Society of Actuaries strongly preferred.
    Relevant Work Experience, Knowledge, Skills, and Abilities


    • 15+ years of actuarial experience with ASA; or 12+ years' experience with FSA.
    • 10+ years health insurance actuarial experience, preferably in Medicare.
    • Ability to analyze complex health insurance issues such as risk modeling, impact of provider contracting changes, etc.
    • Strong understanding of actuarial principles & methodologies related to Medicare Advantage pricing and product design.
    • Understanding of government benefits and design.
    • Proven track record of successfully overseeing multiple large (company/divisional) projects.
    • Strong organizational skills and ability to prioritize and successfully manage multiple priorities/deadlines.
    • Strong management and leadership skills - ability to develop and motivate staff.
    • Excellent written and verbal communicator - need to be able to summarize complex analyses succinctly and be able to
    present results to senior management and others effectively.

    • Executive presence; comfortable speaking with all organizational levels, within and external to, the company.
    • Proficient with MS Office (Word, Excel, Access, PowerPoint, Outlook).
    Additional Information


    • Requisition ID:
    • Hiring Range: $162,000-$302,400

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