Actuarial Director, Health Economics
Found in: Appcast Linkedin GBL C2 - 2 weeks ago
Essential Responsibilities:
- Direct health economics strategy. Work with VP/Chief Actuary, Health Services, Provider Network, Actuarial Pricing and other leadership areas to ensure consistency with partnering departments and alignment with company strategy/goals.
- Make documented recommendations based on the analysis of information regarding methods to reduce costs.
- Collaborate with pricing actuaries to ensure actual and/or expected outcomes of health economics programs are reflected in premium rates. Provide actuarially sound pricing assumptions and analysis, including supporting actuarial memoranda where necessary.
- Coordinate business activities by maintaining collaborative partnerships with key departments.
- Actively participate in various strategic and internal committees in order to disseminate information within the organization and represent company philosophy.
- Provide leadership and supervision to a team of actuarial students, credentialed actuaries, and non-actuarial analysts.
- Assist with hiring, staff development, coaching, performance reviews, corrective actions, and termination of employees. Provide feedback, including regular one-on-ones and performance evaluations, for direct reports.
- Provide input into operational and strategic initiatives as they relate to the actuarial functions of the company.
- Participate in the design and execution of research activities performed within PacificSource.
- Responsible for process improvement and working with other departments to improve interdepartmental processes. Work with staff to promote utilization of lean methodologies for continuous improvement throughout the department.
- Directs the assessment of various elements of risk, cost, and utilization, and its financial impact upon PacificSource.
- Responsible for developing the organization's targeted cost and utilization trend through regular and systematic analysis of experience and forecasting of financial and statistical data in a manner that is actuarially sound, competitive in the marketplace, and provides income in accordance with organization goals and objectives.
- Manage the development, implementation, and maintenance of health economics models, coordinating with other departments to ensure compliance with regulatory requirements and consistency with PacificSource policies.
- Assist in the development and monitoring of clinical programs and provider contracts. Product development activities include: proposing program adjustments, creating organizational discipline around the management of cost and utilization trends, modeling risks and recommending provider contract parameters, reviewing draft provider contracts, monitoring accuracy of contract implementation and measuring contract performance, planning and execution of ongoing risk management, and making presentations to senior executive management.
- Stay informed regarding changes to actuarial curriculum and requirements. Propose updates to student program as needed.
- Assist in the development of department budgets.
Supporting Responsibilities:
- Meet department and company performance and attendance expectations.
- Follow the PacificSource privacy policy and HIPAA laws and regulations concerning confidentiality and security of protected health information.
- Perform other duties as assigned.
SUCCESS PROFILE
Work Experience: At least six years health actuarial experience and three years management experience required.
Education, Certificates, Licenses: Baccalaureate degree in mathematics, statistics, actuarial science, or a related field. Enrolled as an Associate or Fellow in Society of Actuaries, and active member in good standing of American Academy of Actuaries. Fellow in Society of Actuaries preferred.
Knowledge: Must possess the knowledge and assume responsibility for performing the functions of the job position. Must perform and be responsible for the functions in a manner which promotes confidence in the person's abilities. Ability to accomplish tasks accurately under pressure, determine priorities, and to meet deadlines. Ability to identify and define problems, design and then implement solutions, and further monitor results, in a continuous cycle. Is creative and innovative in responding to challenges. Ability to apply actuarial methods and modeling techniques. Verifies and documents assumptions, justifies analysis and recommendations with sound logic and actuarial principles, and adheres to Actuarial Standards of Practice.
Competencies
Authenticity
Building Organizational Talent
Coaching and Developing Others
Compelling Communication
Customer Focus
Empowerment/Delegation
Emotional Intelligence
Leading Change
Managing Conflict
Operational Decision Making
Passion for Results
Environment: Work inside in a general office setting with ergonomically configured equipment. Travel is required approximately 5% of the time.
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