Director, y Actuary

1 month ago

Columbus, Ohio, United States OhioHealth Full time
We are more than a health system. We are a belief system. We believe wellness and sickness are both part of a lifelong partnership, and that everyone could use an expert guide. We work hard, care deeply and reach further to help people uncover their own power to be healthy. We inspire hope. We learn, grow, and achieve more - in our careers and in our communities.

Job Description Summary:

As Sr Advisor Actuary, you will plan, organize, direct, and staff actuarial activities required to analyze and achieve target pricing levels. You will leverage your understanding of insurance business, products, markets, and the regulatory environment to influence pricing/reserving/modeling strategies and business decisions for commercial (self-funded and fully insured), individual, and government programs, aligning objectives with the organization's goals and client needs.

Minimum Qualifications:

Bachelor's Degree: Actuarial Science
JOB SUMMARY

As Sr Advisor Actuary, you will plan, organize, direct, and staff actuarial activities required to analyze and achieve target pricing levels. You will leverage your understanding of insurance business, products, markets, and the regulatory environment to influence pricing/reserving/modeling strategies and business decisions for commercial (self-funded and fully insured), individual, and government programs, aligning objectives with the organization's goals and client needs.

RESPONSIBILITIES AND DUTIES

Demonstrates strong abilities and/or a proven record of success as a team/functional leader in the following areas:
  • Analyzing clients medical claim data to understand historical trends and suggest opportunities to implement savings initiatives.
  • Using best practices to perform actuarial modeling (including modeling of plan design alternatives), data analysis, and risk assessment.
  • Working with large, complex data sets to build models and leverage data visualization tools to provide insights to leadership and clients, with intent to influence business decisions.
  • Employing entrepreneurial capability to help identify and evaluate new business opportunities.
  • Creating a strategic roadmap for new product, program, or market opportunities by evaluating financial performance and/or developing a proforma.
  • Analyzing of company's financial statements, finding opportunities to enhance reporting.
  • Completing IBNR reserve analyses and assessing actuarial balances as part of year-end financial audit.
  • Researching business and industry trends, as well as competitor pricing strategies, to develop a point of view and provide team and industry thought leadership.
  • Evaluating the team's and/or client's end-to-end risk adjustment process, evaluating the return on investment for each operational activity and vendor.
  • Supporting Value Based Care contracting and analytics for payers, providers, and health services organizations.
  • Developing predictive analytics to help identify gaps within the health plan's coding procedures and optimize its revenue stream.
  • Interpreting and applying regulatory requirements to help the team and clients meet both compliance and strategic objective.
  • Creating comprehensive and compliant rating manuals, actuarial memorandums, and other exhibits for regulatory filings, and providing rate filing support to ensure speed-to-market.
  • Collaborating with cross-functional business partners in Finance, Underwriting, Sales, Operations, Network, Product, Legal and Compliance to achieve desired results.
  • Continuously innovating and improving processes, tools, and products to drive business growth and profitability, and to maintain a competitive edge in the market.
  • Advanced knowledge of broad health and welfare products & services, including knowledge of alternative fee arrangements to provide a point of view on pricing strategies.
MINIMUM QUALIFICATIONS
  • Fellow of the Society of Actuaries (FSA) Designation required.
  • Preferred Fields of Study: Actuarial Science, Statistics, Mathematics, Mathematical Statistics, Finance, Economics, Business Administration/Management.
  • Minimum of 7 years (10+ years preferred) in actuarial roles within the healthcare and/or health insurance industry.
Work Shift:
Day

Scheduled Weekly Hours :
40

Department
Corporate Finance

Join us
... if your passion is to work in a caring environment
... if you believe that learning is a life-long process
... if you strive for excellence and want to be among the best in the healthcare industry

Equal Employment Opportunity

OhioHealth is an equal opportunity employer and fully supports and maintains compliance with all state, federal, and local regulations. OhioHealth does not discriminate against associates or applicants because of race, color, genetic information, religion, sex, sexual orientation, gender identity or expression, age, ancestry, national origin, veteran status, military status, pregnancy, disability, marital status, familial status, or other characteristics protected by law. Equal employment is extended to all person in all aspects of the associate-employer relationship including recruitment, hiring, training, promotion, transfer, compensation, discipline, reduction in staff, termination, assignment of benefits, and any other term or condition of employment

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