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Director of Actuarial Services
FSA is required
Health Insurance experience is required
About Our Client
Our client is a well known and well regarded Health Insurance business in the heart of New York City. This client offers MLTC, FIDA, Medicare Advantage, and Select Health Plans.
The Director of Actuarial Services is responsible for the following:
- Develops, implements and manages the risk management of new product lines, including PACE, Medicare Advantage SNP, and Medicare Part D Pharmacy.
- Contributes actuarial expertise to the benefit design process in order to differentiate new products from market competitors. Conducts feasibility studies and makes recommendations to management.
- Oversees regulatory reporting (Dept of Insurance, Dept of Health, National Association of Insurance Commissioners, etc.) associated with new product lines. Responsible for actuarial soundness of risk based capital reporting.
- Ensures the actuarial soundness of reported medical claim IBNR (Incurred But Not Reported) reserves for all product lines. Focuses on key areas including nursing home and home health aide services in MLTC (Managed Long Term Care) and PACE product lines; inpatient, outpatient, specialist, primary care, and ancillary services in Medicare Advantage and PACE product lines.
- Develops and maintains policies and procedures associated with the claim IBNR reserving function, including new categories of medical claims. Develops process controls, including claim lag reports and denied/pending reports to estimate IBNR. Assures consistency of reports with general ledger liability balances.
- Evaluates market developments, primarily at the federal level, that may have an affect on the overall risk profile of participation in Medicare Advantage.
- Uses actuarial techniques to evaluate the viability of the organization's participation in federal and state risk-based initiatives covering dual eligible populations.
- Collects and prepares financial data and analyses for budgets and risk-based premium rate proposals.
- Evaluates the process controls with respect to the completeness and reasonableness of the data collection methodology of at risk-adjusted business. Serves as a liaison to outside actuarial consultants on related issues.
- Performs all duties inherent in a senior managerial role. Ensures effective staff training, evaluates staff performance, provides input for the development of the department budget, and hires, promotes and terminates staff and recommends salary actions, as appropriate.
- Participates in special projects and performs other duties as required.
The Successful Applicant
- Fellow of the Society of Actuaries (FSA) required.
- FSA status, with an emphasis on health care preferred.
- Bachelor's Degree in Mathematics, Actuarial Science, Statistics, or related discipline, required.
- MBA, MPH, or MPA preferred.
- Minimum five years of progressively responsible actuarial/finance experience in a Managed Care or related organization (three years for Masters qualified) required.
- Understanding of community rated and individually risk-adjusted funding mechanisms, provider reimbursement arrangements, and member risk classifications required.
- Two years supervisory experience required.
- Outstanding PC skills, including Excel, Access and VBA required. Excellent analytical and presentation skills, required.
- Experience with SAS, Oracle Discoverer or equivalent software preferred.
- Knowledge of PeopleSoft or Oracle accounting software preferred.
What's on Offer
Competitive offer based on experience level