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Actuarial Manager, Government Pricing

1 month ago

Portland, United States PacificSource Full time
Looking for a way to make an impact and help people?

Join PacificSource and help our members access quality, affordable care

PacificSource is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to status as a protected veteran or a qualified individual with a disability, or other protected status, such as race, religion, color, national origin, sex, sexual orientation, gender identity or age.

Diversity and Inclusion: PacificSource values the diversity of the people we hire and serve. We are committed to creating a diverse environment and fostering a workplace in which individual differences are appreciated, respected and responded to in ways that fully develop and utilize each person's talents and strengths.

Provide actuarial services for all government lines of business. Ensure sound actuarial analysis of risk, resulting in the attainment of PacificSource's financial and enrollment goals. Work with VP to manage development and implementation of rating models for Medicare and Medicaid business. Provide documented input on decisions which impact the risk assumed through various current or proposed activities. Provide guidance to team members regarding company policies, mandates, and workflow. Oversee hiring, productivity, and quality of the staff's work. Train and evaluate team member performance.

Essential Responsibilities:
  • Together with the members of the Actuarial Services team, responsible for developing the organization's Medicare bids 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.
  • Responsible for working with state and federal templates to report PacificSource experience and trend to support annual Medicaid bid, including pulling in information from outside the claims data source, performing analysis to address relevant questions, and communicating developments to CFO, VP of Actuarial and Underwriting, and VP of Medicaid Programs.
  • Provide leadership and supervision to a team of actuarial students, credentialed actuaries, and non-actuarial analysts.
  • Assist in the development of new products for the Medicare line of business. Product development activities include: proposing alternative product structures, writing product specifications, modeling risks and recommending rates, reviewing draft contracts, corresponding with CMS, planning and execution of ongoing risk management, and making presentations to senior executive management.
  • Under general direction, develop requirements for and identify information needed to accurately assess various elements of risk, cost, and utilization, and its financial impact upon PacificSource.
  • Provide support to Medicare Programs Advisory and Medicare Leadership Team regarding bid development, service area changes, and the Financial Improvement Plan.
  • Provide input into operational and strategic initiatives as they relate to the actuarial functions of the company.
  • Ensure compliance required by State and Federal laws.
  • Prepare required rate filings, bids, and supporting experience exhibits.
  • Participate in the design and execution of research activities performed within PacificSource.
  • Make documented recommendations based on the analysis of information regarding methods to reduce costs through benefit design modifications or provider contracting.

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.

Work Experience:

At least four years' experience in the managed health care actuarial environment. Thorough knowledge of generally accepted actuarial principles.

Education, Certificates, Licenses:

Baccalaureate degree in business, mathematics, or a related field. Associate of the Society of Actuaries (ASA) or Fellow of the Society of Actuaries (FSA) required.

Knowledge:

Ability to work with advanced mathematical concepts including statistics and algebra; and financial analysis skills. Must possess the knowledge and assume responsibility for performing actuarial projections, ratings, and recommendations. Must promote confidence in abilities, including, but not limited to:
  • Showing creativity and innovative problem solving in response to the challenges confronted by PacificSource, provide actuarial expertise and planning activities in conjunction with company principles.
  • Justifying analysis and recommendations with sound logic and actuarial principles.
  • Performing activities in a timely manner to meet organization's need, with a high level of accuracy. Verifies and documents assumptions. Recognizes and utilizes overt and subtle data variables.

Ability to communicate effectively both orally and in writing with all levels within the company, and with brokers, groups, and state regulators. Ability to provide analysis and application of actuarial methods and modeling techniques, and to interpret and make related recommendation. Must have analytical ability in identifying problems, developing solutions and implementing a chosen course of action.

Competencies:

Building Trust

Building a Successful Team

Aligning Performance for Success

Building Partnerships

Customer Focus

Continuous Improvement

Decision Making

Facilitating Change

Leveraging Diversity

Driving for Results

Environment:

Work inside in a general office setting with ergonomically configured equipment. Travel is required approximately 10% of the time.

Skills:
Accountable leadership, Communication, Data-driven & Analytical, Delegation, Listening (active), Situational Leadership, Strategic Thinking

Our Values

We live and breathe our values. In fact, our culture is driven by these seven core values which guide us in how we do business:
  • We are committed to doing the right thing.
  • We are one team working toward a common goal.
  • We are each responsible for customer service.
  • We practice open communication at all levels of the company to foster individual, team and company growth.
  • We actively participate in efforts to improve our many communities-internally and externally.
  • We actively work to advance social justice, equity, diversity and inclusion in our workplace, the healthcare system and community.
  • We encourage creativity, innovation, and the pursuit of excellence.

Physical Requirements: Stoop and bend. Sit and/or stand for extended periods of time while performing core job functions. Repetitive motions to include typing, sorting and filing. Light lifting and carrying of files and business materials. Ability to read and comprehend both written and spoken English. Communicate clearly and effectively.

Disclaimer: This job description indicates the general nature and level of work performed by employees within this position and is subject to change. It is not designed to contain or be interpreted as a comprehensive list of all duties, responsibilities, and qualifications required of employees assigned to this position. Employment remains AT-WILL at all times.