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Actuarial Lead
5 months ago
Regular
Exempt
GENERAL DESCRIPTION
Responsible for analyzing pricing, financial reporting and reserves, and product development for all companies' products. Accountable for assessing the financial risks associated with products, and related services. Provide guidance and analytical support to optimize pricing, manage risk, and ensure the financial stability and competitiveness of the organization.
ESSENTIAL FUNCTIONS
• Researches and analyzes various types of data to produce reserve estimates and/or actuarial support for filings with state insurance departments; and/or to implement new rates and rating plans, using existing procedures, and recommending changes where appropriate.
• Analyzes data for developing and proposing solutions for actuarial or product line management.
• Oversees the determination of the reserve for claims necessary in the estimation of incurred claims included in the financial statements. Assess and recommend the actuarial liabilities/receivables to be reported in the financial statements.
• Develop the budget by-product of both lines of business and create all necessary supporting documentation for internal and external purposes including but not limited to the budget package.
• Responsible for the communication between the certifying actuary and MCS, preparing data, and supporting assumption development with reviewers for rate and product approvals.
• Participate in the development, which includes assessing the actuarial assumptions to be used in the pricing model, providing recommendations for product design, and completing the required documentation. Work with multidisciplinary areas to serve as liaison with external actuarial consultants.
• Prepare experience studies and monitor each segment's profitability.
• Participate in the development and revision of statistical and actuarial models that reflect the tendencies of costs and memberships by business segment.
• Provides support and reviews the development of rates for capitated and FFS agreements.
• Responsible for the design of reports and spreadsheets that describe and present actuarial and statistical information according to its type of financing.
• Assess the actuarial impact of potential regulation changes that affect premium or medical costs and prepare a communication report describing the impact and the analysis developed.
• Identify and report significant issues and underlying problems, accompanied by proposed solutions, promptly to leadership. Also, resolving issues before health plan performance results are impacted.
• Prepare and deliver presentation materials for management level, internal or external users.
• Participates and collaborates with internal and external audits, in the department processes automation, corporate and departmental projects, and other similar tasks.
• Participates in the implementation of tactical plans, and follows up on assigned tasks, projects, or objectives to ensure that expectations are met.
• Must comply fully and consistently with all company policies and procedures, with local and federal laws as well as with the regulations applicable to our Industry, to maintain appropriate business and employment practices.
• May carry out other duties and responsibilities as assigned, according to the requirements of education and experience contained in this document.
MINIMUM QUALIFICATIONS
Education & Experience: Bachelor's degree (Master's degree, preferable) in Actuarial Sciences, Mathematics, Statistics, Finance, or Economy. At least five (5) years of previous experience in a managed-care environment preferably in the Healthcare industry.
"Proven experience may be replaced by previously established requirements."
Certifications / Licenses: completed at least four (4) SOA examinations.
Other: Knowledge of SQL, SAS, Oracle, and MS Office (Word, Excel). Possess an approved actuarial examination. Must be part of the Actuarial Association.
Languages:
Spanish - Advanced (writing, comprehension, reading, or conversational)
English - Advanced (writing, comprehension, reading, or conversational)
"Somos un patrono con igualdad de oportunidad en el empleo y tomamos Acción Afirmativa para reclutar a Mujeres, Minorías, Veteranos Protegidos y Personas con Impedimento"
