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Lead Actuary - Medicare
ASA is preferred
Medicare 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.
- Develops strong knowledge of relevant data sources that are used for analysis within the Actuarial Department. Engages in business intelligence groundwork that leads to the production of business analytics for actuarial processes.
- Stays abreast of trends and developments surrounding Medicare regulatory and market developments, and assesses risk in actuarial considerations. Makes recommendations on product development options and strategies according to assigned lines of business based on conclusions from assessments.
- Determines appropriate strategic competitive pricing for products. Oversee and directs all pricing reviews for products.
- Develops performance monitoring processes and interpreting/presenting the resulting information. Plans and develops budgets, high level reviews and analyses for target development.
- Leads complex actuarial projects where analysis requires an in-depth evaluation of factors.
- Serves as actuarial project lead for all regulatory entities - Centers for Medicare and Medicaid Services (CMS), National Association of Insurance Commissioners (NAIC), Department of Health (DOH), rate reviewers, auditors, etc.
- Leads key quantitative and qualitative analyses inclusive of trend development, pricing studies, reserving, financial reporting, and monthly closing processes.
- Researches deviations between financial modeling and real time figures. Provides insightful recommendations that educate management on product performance and improve future planning. Presents actuarial findings to Senior Management to support recommendations and influence revisions.
- Leads full actuarial analyses to determine risk profiles and emerging experience of any new and future member enrollment cohorts. Provides input into premium rate proposals and service area expansion applications.
- Participates in the Actuarial Committee by identifying gaps in needed research and designs actuarial model enhancements.
- Liaises with internal departments to create strong lines of communication in all areas that impact actuarial analysis. Oversees the collection and preparation of materials to be used as references in audit related activities.
- Collaborates with internal/external compliance departments to establish a robust 'audit-proof' environment for all actuarial analysis and reporting. Expertise with the NAIC Model Audit Rule.
- Participates in special projects and performs other job duties as required.
The Successful Applicant
- Associate of the Society of Actuaries (ASA) designation REQUIRED
- Member of the American Academy of Actuaries (MAAA) preferred.
- Bachelor's Degree in Mathematics, Actuarial Science, Statistics, Biostatistics, Public Health, or related discipline required.
- Minimum of six years of progressively responsible actuarial experience in a Health Plan/ Managed Care organization at least some of which in a supervisory role.
- Expert knowledge of Actuarial Standards of Practice (ASoPs), Centers for Medicare and Medicaid Services (CMS), National Association of Insurance Commissioners (NAIC).
- Expert knowledge of core health actuarial processes including Pricing, Valuation, and Budgeting/Forecasting required.
- Experience composing and facilitating presentations.
- Efficiency in manipulating and analyzing large and complex data sets from multiple sources using SAS.
- Proficient in MS Excel spreadsheets and Visual Basic.
- Ability to communicate quantitative analyses and results in a clear, precise and actionable manner.
What's on Offer
Competitive offer with potential for sign on bonus.