The Director Actuary will coordinate work with CCOK's external actuaries, work closely with Marketing, Finance, Underwriting and other departments to find solutions to assist the company in achieving long-term profitable growth. The Director Actuary will have deep Health Insurance experience and a particular focus in Medicare Advantage, to direct the calculation of risk, analysis of trends, and pricing for products and services provided by the health plan.
KEY RESPONSIBILITIES:
- Works with leadership to develop an internal actuarial function for CCOK.
- Coordinates with Underwriting/Product team and external actuaries on Medicare Advantage and ACA rate filings
- Performs analysis and maintenance of Large Group pricing models
- Leads team responsible for Medicare Advantage and ACA Risk Adjustment
- Provides custom pricing review and support for prospective and existing Large Group customers
- Provides analyses to support network design, provider contracts and area factors.
- Provides trend analysis such as cost of care, medical loss ratio, and ACA plan profitability and enrollment
- Supports Medical Management and Pharmacy teams on ad hoc projects
- Monitors market dynamics and develop competitive analysis reports
- Provides oversight and support to IBNR, PDR, and other actuarial accrual development
- Other miscellaneous analytical analysis as needed.
- Performs other job-related duties as required.
QUALIFICATIONS:
- Extremely proficient in Microsoft products: Excel, Access and Word.
- Proficient in SAS and/or other SQL based tools.
- Knowledge of health insurance underwriting principles.
- Hands on experience with the Medicare Advantage pricing and bid process.
- Experience with Medicare Advantage and ACA related Risk Adjustment and RADV reporting and analysis.
- Strong written and verbal communication skills.
- Ability to clearly explain complex statistics and technical details to a non-technical audience.
- Ability to thrive in a dynamic and fluid environment.
- Work independently to meet external and internal deadlines.
- Successful completion of Healthcare Sanctions background
EDUCATION/EXPERIENCE:
- B.S. Mathematics, Statistics, Actuarial Science or related degree.
- Associate of the Society of Actuaries (ASA) required, Fellow (FSA) preferred.
- 8+ years' actuarial experience in health insurance.
CommunityCare is an equal opportunity at will employer and does not discriminate against any employee or applicant for employment because of age, race, religion, color, disability, sex, sexual orientation or national origin