Director, Actuarial Services

1 month ago


New York, New York, United States EmblemHealth Full time
Summary:
  • Provide the analytical resources necessary for the development of overall pricing and reserve setting strategies.
  • Lead projects to analyze current rate structures and develop improvements and alternatives.
  • Coordinate the actuarial staff as needed to support the activities of the affiliates.
Responsibilities:
  • Work closely with Senior Product Management and Finance to analyze financial performance of blocks of business, including membership, trend, and financial analyses.
  • Work collaboratively with all areas of the organization to identify opportunities to improve product performance.
  • Oversee development and filing of premium rates for all products with the appropriate regulatory authority (e.g., CMS, New York Dep't of Health).
  • Work closely with Risk Adjustment and other areas to optimize risk adjustment and related programs to increase EmblemHealth's premium revenue for these segments.
  • Supervise and develop direct reports accountable for Medicare and State Sponsored areas, as well as other staff.
  • Regular attendance is an essential function of the job.
  • Perform other duties as assigned or required.
Requirements:
  • Bachelor's degree in Actuarial Science, Mathematics, other physical science, or related finance/business degree required
  • Associate of the Society of Actuaries (ASA) required
  • Member of the American Academy of Actuaries (M.A.A.A.) preferred
  • Fellow of the Society of Actuaries (F.S.A.) preferred
  • 10+ years of relevant, professional work experience and/or education required
  • 8+ years of actuarial experience with ASA; or 7 + years' experience with an FSA required
  • 3+ year of management experience, preferably in the managed care industry required
  • Prior management experience required
  • Comprehensive understanding of actuarial principles and methodologies with strong mathematical and analytical skills required
  • Excellent written and oral communication skills to deliver complex information and achieve positive results required
  • Capable with Excel, data extraction, simulations, automation required
  • Proficiency with MS Office (Word, Excel, Access, PowerPoint, Outlook) required
  • Strong data querying skills using tools such as SQL or SAS Enterprise Guide preferred
  • Knowledge of reimbursement methodologies required

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