Actuarial, Sr. Leader, Medicare

  • 36254
  • Health - Actuarial
  • |
  • New York, United States
  • |
  • Nov 15, 2019
  • Lead a team of analysts in managing all responsibilities related to setting and filing CMS Bids for Medicare.
  • Direct Bill as well as setting premium rates / factors and experience rating methodologies for the Medicare Employer Group Market.
  • Work collaboratively with Network, Informatics, Product and Finance and manage work flow and dependencies with external Actuarial consultants as needed.
  • Will be responsible for providing Financial Forecasts in support of the Corporate Budgeting process related to these blocks of business as well as overseeing the development and analysis of historical revenue and claim expense experience reporting and provide necessary support to Finance partners for Federal MLR and other reporting requirements.
  • Will be responsible for leading actuarial role in CMS bid audits as well as working with external auditors at year end and company’s internal auditors for the MAR cycles.
  • Will be relied upon as a critical thought leader and innovator to build the tools/models and knowledge base necessary to enable company to take full responsibility for the Medicare premium rate development and CMS Bid Submission process as well as to build out actuarially sound Experience Rating formulas and rating factors for Group business.
  • Bachelor’s Degree in Business, Math or related field.
  • Credentialed ASA or FSA.
  • Minimum 7 years’ experience as an ASA/FSA working for Health Insurance Company or Health Care Consulting firm directly involved in Medicare Pricing / Bid Submissions.
  • Supervisory experience overseeing Medicare line of business.
  • In depth knowledge of Medicare Bid Mechanics and Pricing methodology.
  • Strong spreadsheet and programming skills.
  • Self-Starter, Innovative thinker, ability to self-teach.
  • Strong critical thinking and problem-solving skills.
  • Strong communication and interpersonal skills.
  • Attention to detail and accountable.
  • Effective team player.
  • Effective at driving change, process improvement.