Healthcare Actuary – Medicare Advantage

posted on April 16, 2020

Job Description

Location: Oakland, CA

Type: Permanent

Non-negotiable Requirements:

  • Minimum eight (8) years of actuarial experience and (ASA or FSA) or Fellowship (FSA from Society of Actuaries) & four (4) years of actuarial experience.
  • Bachelor’s degree in mathematics, statistics, computer science or a related .
  • Attainment of ASA.
  • Medicare Advantage actuarial experience (two or more years) required

What are the nice-to-have skills?

  • Strong technical actuarial skills
  • Management/supervisory experience preferred
  • Medicare Advantage actuarial experience (two or more years) required
  • Demonstrated ability to communicate and work collaboratively with actuarial teams and non-actuarial business partners

Job description:

  • Provide actuarial services to develop best-practice actuarial models and promote implementation Program-wide.
  • Maintain accountability for the development of the organization’s rate structure, maintenance of adequate reserves, and development of new products.
  • Provide data/analytic expertise to support actuarial services including financial reporting, trend analysis, utilization studies, rate development and claims liability estimates.

Essential Functions:

  • The Actuary is approaching high levels of technical actuarial specialization and expertise.
  • Areas of specialization may include: 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.
  • This position may advise management on actuarial or mathematical techniques in determining appropriate courses of action.
  • This position may oversee projects as the highest level individual contributor.

Experience: 

  • Minimum eight (8) years of actuarial experience and (ASA or FSA) or Fellowship (FSA from Society of Actuaries) & four (4) years of actuarial experience.

Education, License, Certification, Registration: 

  • Bachelor’s degree in mathematics, statistics, computer science, etc.
  • Attainment of ASA.

Additional Requirements:

  • Analytical programming experience (use of Excel, Access, and other Business Intelligence tools).
  • Knowledge of core actuarial concepts (reserving, pricing, forecasting and trend analysis).
  • Understanding of health care cost structures (fee schedules, actuarial cost categories, and health care utilization codes).
  • Knowledge of key market segments (individual, small group, etc.) OR knowledge of key government programs (Medicare, Medicaid, etc.).
  • Must be able to work in a Labor/Management Partnership environment.

Preferred Qualifications:

  • Serves as the regional Actuarial lead for Medicare Advantage.
  • 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 MA actuarial leads to direct improvements in capabilities, efficiency, and integration for 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 WA 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 (CMS) desk review and internal/external audits as applicable with respect to WA Medicare work
  • Support the training and development of junior staff
  • 8 years of health actuarial experience
  • Associate or Fellow of the Society of Actuaries
  • Member of the American Academy of Actuaries
  • Strong technical actuarial skills
  • Management/supervisory experience preferred
  • Medicare Advantage actuarial experience (two or more years) required
  • Demonstrated ability to communicate and work collaboratively with actuarial teams and non-actuarial business partner

 

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