Vice President - Chief Actuarial Officer

  • 34176
  • Life - Actuarial
  • |
  • Tennessee, United States
  • |
  • Sep 11, 2018
Insurance
RESPONSIBILITIES
  • Works closely with senior leaders to ensure that risk management practices and policies support the organization's operating objectives.
  • Integrates cost mitigation efforts by coordinating risk reduction, risk finance and claims management across the organization.
  • Provides the professional leadership necessary to establish and maintain an effective and innovative claims management function.
  • Collaborates closely with senior executives to establish and implement procedures, practices and controls that enhance and integrate risk management capabilities.
  • All work is performed with a direct reflection of the Mission, Vision and Values of the company.
  • Create a vision for the actuarial function, and for population health risk as a whole, that will support internal needs and has the potential to expand services to external customers.
  • Participate in developing: Risk sharing strategies, Health plans and payer contracts, Smart health product offerings, retention levels and reinsurance.
  • Create and employ healthcare data analytics to assist in the creation of disease and condition registries and identification of evidence-based medicine gaps in care and information.
  • Support the quality, cost and contract modeling processes for all membership types.
  • Determine accurate pricing policies for Smart health and for the company's risk bearing insurer contracts.
  • Participate in the professional and hospital services reimbursement strategies.
  • Participate in due diligence work regarding health plan acquisitions.
  • Contribute to the development of an assessment methodology for Mission Point, the company’s population health model. Pursue continuing education and professional organization memberships to advance knowledge of the trends in healthcare that will affect the assumption of risk by the company in the areas of capitation risk, contract risk, provider network effectiveness, and value-based services.
QUALIFICATIONS
  • Bachelor's degree and designated as a Fellow of the Society of Actuaries, required.
  • 10 years of experience in pricing products within a health plan or in a consultant role required.