Director, Actuarial Services
5 days ago
Join us in making a career in Independent Living Systems, an industry leader in managing home and community-based programs for over 20 years. Independent Living Systems, LLC and its subsidiaries offer a comprehensive range of clinical and third-party administrative services to managed care organizations and providers that serve high-cost, complex member populations in the Medicare, Medicaid, and Dual-Eligible Market. ILS provides tailored integrated solutions aimed at improving health outcomes while rebalancing costs, addressing social determinants of health and connecting members with community-based resources.
Position Summary
The Director of Actuarial Services will lead an analytic team responsible for monitoring and analyzing financial performance associated with claims experience and capitation rate revenue. The Director of Actuarial services will work with executive leadership and cross finance functions to understand drivers of performance and develop solutions to emerging challenges.
Essential Functions
- Conduct interviews and hiring of direct reports. Complete a 90-day introductory and annual performance evaluation of each direct report. Facilitate professional growth and improved proficiency of staff who are direct and indirect reports through mentoring and training. Conduct ongoing performance management of each direct report; establishes performance goals; and measures performance against goals.
- Apply concepts and tools of Financial Analytics, such as medical expense cost-effectiveness and premium capture forecasting/trend studies, to ensure leadership can easily understand where the organization is performing well and where focus is required in medical margin improvement. Analysis tracks medical margin financial performance and drivers (utilization and unit cost) by product, service and geography.
- Oversee monitoring and analysis of service spending and reimbursement trends to identify opportunities for improving financial performance.
- Work with the CFO and SVP of Medical Economics to prepare and present regular financial reports to senior leadership, including forecasting future financial performance.
- Participate in strategic and operational meetings related to capitation rate development and risk adjustment with internal and external actuaries, providing insights and analytics that support early communication of emerging issues.
- Conduct and oversee analysis related to claims data based capitation rate reconciliations and liability estimation.
- Conduct and oversee analyses that support development and reconciliation of alternative payment arrangements with providers, including risk payments, shared savings arrangements, and other value based payment methods.
- Oversee development of financial analysis methodologies for internal stakeholders, including establishing and documenting analytic and modeling standards.
- Perform other duties as required or assigned.
Education and Experience
- Bachelor's degree in economics, finance, mathematics or similar field required; advanced degree or additional relevant training strongly preferred.
- At least 8 years' financial analytic experience with health insurance, health plans, clinical programs, or related industry; Medicaid and/or Medicare experience preferred.
Required Skills
- Strong technical aptitude in financial modeling, mathematics, and statistics.
- Proficiency with Microsoft Office suite, including expertise with Excel.
- Exposure to analytic tools such as Oracle-based data warehouses, SAS, SQL, Power BI, and Tableau.
- Demonstrated leadership ability to drive results that are aligned with organizational goals.
- Proactive, assertive, and creative approach to problem-solving.
- Hands-on approach, with high attention to detail and accuracy.
- Ability to translate complex analytic concepts for non-analytic audiences.
EEO Statement
In compliance with the Drug-Free Workplace Act of 1988, Independent Living Systems has a longstanding commitment to provide a safe, quality-oriented, and productive work environment. Alcohol and drug abuse pose a threat to the health and safety of ILS employees and to the security of the company's equipment and facilities. For these reasons, ILS is committed to the elimination of drug and alcohol use and abuse in the workplace.
Independent Living Systems, LLC, and its subsidiaries, including FCC, provides equal employment opportunity to all individuals regardless of their race, color, creed, religion, gender, age, sexual orientation, national origin, disability, veteran status, disability, ancestry, or any other characteristic protected by state, federal, or local law. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
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