Senior Actuary

US-RI-Providence
Req No.
2017-7984
Department
Fiscal Operations
Type
Regular Full-Time
Category
Accounting/Finance

Overview

The Senior Actuary is a key member of the Finance management team whose responsibility is to lead all pricing and rating support across relevant products, working with both federal and state agencies and perform any other required actuarial studies for senior leadership. For any actuarial activities that cannot be completed in-house, this position will manage use of outsourced underwriting activities, including scoping work, vendor management, and performance management.  The Sr. Actuarial is also responsible for supporting risk adjustment measurement and maximization as well as trend development for pricing and trend analysis purposes.

Responsibilities

  • Leads, designs, and develops actuarial assumptions used in pricing, bid development, reserving, and regulatory filings
  • Oversees the development of the Commercial rating models along with oversight of external actuaries utilized during this process and make strategic decision making recommendations around the program and product pricing
  • Makes recommendations to protect the organization’s financial integrity by completing accurate financial analysis and risk assessments to evaluate specific strategic options and opportunities
  • Prepares highly complex financial/actuarial reports and presents to executive leadership
  • Participate and lead financial and actuarial analysis as it relates to strategic product development
  • Leverages predictive modeling for analysis and operational applications
  • Directs the supervision of the Actuarial Services Team to include hiring, work allocation, scheduling, training and professional development, coaching, problem resolution, performance evaluation and related supervisory activities.
  • Uses depth of knowledge and experience to guide and develop colleagues and to drive organizational talent
  • Works well and collaboratively with analysts, actuaries and/or other consultants on various projects
  • Supports and works in conjunction with the Risk Adjustment Manager with the analysis of risk adjustment from a financial perspective with a focus on risk adjustment revenue maximization
  • Assess the design and execution of actuarial support and analysis at Neighborhood and transition this knowledge and the management of those processes from outside consultants to internal actuarial where applicable
  • Participate as point of contact between external consultants, auditors, regulators and internal actuarial management as applicable
  • Work with Finance and other plan departments as needed to represent actuarial perspective in identifying, implementing and coordinating improved information flow and tools. Assure actuarial teams ability to provide timely and accurate financial reporting, management discussion and analysis for executive leadership and other stakeholders
  • Meet regularly with Product Leaders, Finance, and Network teams
  • Corporate Compliance Responsibility - As an essential function, responsible for complying with Neighborhood’s Corporate Compliance Program, Standards of Business Conduct, applicable contracts, laws, rules and regulations, policies and procedures as it applies to individual job duties, the department, and  the Company. This position must exercise due diligence to prevent, detect and report unlawful and/or unethical conduct by fellow co-workers, professional affiliates and/or agents

Qualifications

Required:
  • Bachelor’s degree from an accredited college/university with a strong academic background in actuarial science, applied statistics, financial analysis, and insurance
  • 7 or more years of progressively responsible experience with data management and actuarial analysis with a minimum of four years in a management position within a healthcare insurance environment
  • 5 years’ experience as an Associate of the Society of Actuary (ASA) or Fellow of the Society of Actuaries (FSA) designation
  • Current Member of the American Academy of Actuaries (MAAA)
  • Rate filing and/or pricing experience
  • SQL, SAS, or equivalent data base experience such as VBA knowledge
  • Working knowledge of Microsoft Office (MS) tools
  • Experience working with providers and/or insurers in a health insurance setting, especially in regards to large claims or clinical data sets, working with actuarial models to evaluate trends or contract provisions, evaluating experience periods, and performing modeling or predictive modeling
  • Ability to use well developed interpersonal skills to lead and direct the efforts of others, both internally and externally required
  • Must be able to conceptualize and envision the impact of change, and propose new ways to do business
  • Strong analysis skills are required
  • Proven ability to meet deadlines, multi-task, problem solve and use appropriate technology to analyze business problems
  • Strong communications skills, both verbal and written, as well a technical writing, are required

 

Preferred:
  • Master’s degree from an accredited college/university with a strong academic background in actuarial science, applied statistics, financial analysis, and insurance
  • Experience interacting with state or federal regulators, the Centers for Medicare and Medicaid Services (CMS) or other external regulatory or auditing entities
  • Experience with Medicare
  • Project management skills

Neighborhood is an Affirmative Action and Equal Opportunity Employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, gender, sexual orientation, national origin, genetic information, age, disability, veteran status or any other legally protected basis.

Neighborhood is committed to ensuring individuals with disabilities and/or those who have special needs participate in the workforce and are afforded equal opportunity to apply for jobs. If you would like to contact us regarding the accessibility of our Website or need assistance completing the application process, please contact us at recruiting@nhpri.org

Neighborhood is an EOE M/F/D/V and an E-Verify Employer

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