Actuary - Medicare Advantage

  • 37070
  • Health - Actuarial
  • |
  • California, United States
  • |
  • Mar 17, 2020
  • Analysis and interpretation of product line financials to determine premium rates, profit forecasts, reserve adequacy, and other product line evaluations.
  • Applies actuarial science and research, including monitoring developments in actuarial techniques, standards, and assumptions, and the legal and regulatory environment.
  • Analysis and interpretation of product line financials, testing of reserve adequacy, valuation of liabilities, cash flow analysis, and product investment strategy.
  • Determination of pricing structure and premiums, and the origination and evaluation of new product ideas, which are highly specialized, complex, and strategic.
  • May advise management on actuarial or mathematical techniques in determining appropriate courses of action.
  • May oversee projects as the highest level individual contributor.
  • Minimum eight years of actuarial experience and ASA or FSA from the Society of Actuaries & four years of actuarial experience.
  • Bachelor's degree in mathematics, statistics, computer science, etc.
  • Attainment of ASA.
  • Analytical programming experience.
  • Knowledge of core actuarial concepts.
  • Understanding of health care cost structures.
  • Knowledge of key market segments OR knowledge of key government programs.
  • Must be able to work in a Labor/Management Partnership environment.
  • Preferred:
  • Oversees the development of Medicare Advantage bids in the region.
  • Coordinates with the national Part D actuarial team on the development of Part D bids for the region.
  • Collaborates with national and regional business partners to define and execute on the approach to Medicare Advantage bids and analytics and provide attestation to the actuarial soundness of the bids.
  • Participates with other regional actuarial leads to direct improvements in capabilities, efficiency, and integration for company’s bid model, documentation, and related actuarial tools.
  • Develops/enhances tools as needed to support product decisions, market strategies, scenario modeling, competitive analysis, experience projections, etc.
  • Collaborates with business partners in Medicare line of business management, product management, regional finance and management, and other departments to obtain and analyze experience data to support bids and other actuarial analysis - includes development of trend and forecast models.
  • Leads quality assurance activities related to source data and bids for Medicare Advantage.
  • Designs and leads studies to improve bid accuracy and justification.
  • Works with other regional and national Medicare actuarial leads to analyze the impact of legislative and regulatory changes on business and financial results.
  • Leads efforts to support Centers for Medicare & Medicaid Services desk review and internal/external audits as applicable with respect to Medicare work.
  • Support the training and development of junior staff.