Job Requirements
POSITION SUMMARY
The Director of Actuarial Medicare leads and administers the Actuarial Medicare team in the completion of required Medicare Advantage product rate filings, experience reporting, and pricing decisions. The Director of Actuarial Medicare oversees the financial management of Medicare products through strategic formulation, provider contracting design, and support. The Director of Actuarial Medicare certifies Medicare Advantage bids and ensures compliance with all regulatory requirements. The Director of Actuarial Medicare manages and develops actuarial staff and maintains critical actuarial models and systems.
PRIMARY ACCOUNTABILITIES Ensures the Actuarial Medicare team has the right knowledge, skills, and experience to achieve related results. Communicates and clarifies expectations, timeframes, and deliverables. Certifies Medicare Advantage bids and leads the Actuarial Medicare team in developing and maintaining Medicare Advantage pricing models. Oversees the development or required state and federal premium rate and other filings, including responses to regulators' questions and meeting of all filing deadlines. Leads the design, review, and administration of Medicare plans, determines financial soundness and calculations of premiums. Coordinates with Corporate Integrity and Product Development teams for Medicare premium rate filings to ensure timely filing and consistency with insurance laws and regulations. Verifies adherence to all regulatory and certification guidelines, including the Health Insurance Portability and Accountability Act (HIPAA), State, and Federal Guidelines. Directs analysis on Risk Scores, Medicare Stars, and premium projections, including RAPS receivable calculations. Oversees the processing of CMS data files and maintains Medicare databases (MMR, MOR, Beneficiary Files, RAPS Return, MAO-004, etc.). Pursues expenditures to improve operational and financial efficiencies through better use of resources. LEADERSHIP ACCOUNTABILITIES
Define and communicate a clear, compelling vision for the team that effectively ties into the mission and vision of Health First and inspire the team to achieve that vision. Provide leadership, motivation, coaching, feedback and support to foster and strengthen growth and development of an effective, high performing team. Lead change through effective communication, explaining the connection and value to the organization, creating stronger buy-in and urgency, while understanding impact to the team to obtain commitment. Demonstrate openness to hearing diverse ideas and thoughts; create a sense of inclusivity; and encourage collaboration across teams to help break down silos to meet the team's and organization's goals. Recruit, select, grow, and retain highly engaged, high performing diverse and inclusive associates. Display strong strategic and financial acumen in areas of responsibility in alignment with the organization's strategic objectives.
Work Experience
MINIMUM QUALIFICATIONS Education: Bachelor's degree in Mathematics, Actuarial Science, or a relevant field. Work Experience: Seven (7) years' Medicare, or similar actuarial analysis experience, with three (3) years' experience in leadership. Licensure: None Certification: Associate or Fellow of the Society of Actuaries (ASA or FSA) prior to start date and maintained. Membership in the American Academy of Actuaries (MAAA) prior to start date and maintained. Skills/Knowledge/Abilities: Qualified to certify the Medicare Advantage Bid. Knowledge of the Medicare Advantage Bid process and applicable regulations. In-depth understanding of Medicare Advantage revenue systems and strategies. Possess an understanding of Health First Health Plans product offerings. Knowledge of medical benefits, provider reimbursement methodologies, medical and dental terminology, claim adjudication and benefit plan application for Point of Service, HMO, PPO or Medicare plans. Conveys knowledge to others. Ability to communicate highly complex information verbally and in written form which may include strategic plans and projects. Ability to collaborate and interact with staff, internal management, external executive management, providers and external partners. Design, develop and implement highly complex programs, products, technical systems and overall policies in accordance with Health First's strategy. Readily accepts change and influences organizational change to meet strategic goals of Health First. SQL, SAS, and VBA programming languages.
PHYSICAL REQUIREMENTS Majority of time involves sitting or standing; occasional walking, bending, and stooping. Long periods of computer time or at workstation. Light work that may include lifting or moving objects up to 20 pounds with or without assistance. May be exposed to inside environments with varied temperatures, air quality, lighting and/or low to moderate noise. Communicating with others to exchange information. Visual acuity and hand-eye coordination to perform tasks. Workspace may vary from open to confined. May require travel to various facilities within and beyond county perimeter; may require use of personal vehicle.
Benefits
ABOUT HEALTH FIRST
At Health First, diversity and inclusion are essential for our continued growth and evolution. Working together, we strive to build and nurture a culture that recognizes, encourages, and respects the diverse voices of our associates. We know through experience that different ideas, perspectives, and backgrounds create a stronger and more collaborative work environment that delivers better results. As an organization, it fuels our innovation and connects us closer to our associates, customers, and the communities we serve.
Schedule :
Full-Time
Shift Times :
800am_500pm
Paygrade :
EDR
POSITION SUMMARY
The Director of Actuarial Medicare leads and administers the Actuarial Medicare team in the completion of required Medicare Advantage product rate filings, experience reporting, and pricing decisions. The Director of Actuarial Medicare oversees the financial management of Medicare products through strategic formulation, provider contracting design, and support. The Director of Actuarial Medicare certifies Medicare Advantage bids and ensures compliance with all regulatory requirements. The Director of Actuarial Medicare manages and develops actuarial staff and maintains critical actuarial models and systems.
PRIMARY ACCOUNTABILITIES Ensures the Actuarial Medicare team has the right knowledge, skills, and experience to achieve related results. Communicates and clarifies expectations, timeframes, and deliverables. Certifies Medicare Advantage bids and leads the Actuarial Medicare team in developing and maintaining Medicare Advantage pricing models. Oversees the development or required state and federal premium rate and other filings, including responses to regulators' questions and meeting of all filing deadlines. Leads the design, review, and administration of Medicare plans, determines financial soundness and calculations of premiums. Coordinates with Corporate Integrity and Product Development teams for Medicare premium rate filings to ensure timely filing and consistency with insurance laws and regulations. Verifies adherence to all regulatory and certification guidelines, including the Health Insurance Portability and Accountability Act (HIPAA), State, and Federal Guidelines. Directs analysis on Risk Scores, Medicare Stars, and premium projections, including RAPS receivable calculations. Oversees the processing of CMS data files and maintains Medicare databases (MMR, MOR, Beneficiary Files, RAPS Return, MAO-004, etc.). Pursues expenditures to improve operational and financial efficiencies through better use of resources. LEADERSHIP ACCOUNTABILITIES
Define and communicate a clear, compelling vision for the team that effectively ties into the mission and vision of Health First and inspire the team to achieve that vision. Provide leadership, motivation, coaching, feedback and support to foster and strengthen growth and development of an effective, high performing team. Lead change through effective communication, explaining the connection and value to the organization, creating stronger buy-in and urgency, while understanding impact to the team to obtain commitment. Demonstrate openness to hearing diverse ideas and thoughts; create a sense of inclusivity; and encourage collaboration across teams to help break down silos to meet the team's and organization's goals. Recruit, select, grow, and retain highly engaged, high performing diverse and inclusive associates. Display strong strategic and financial acumen in areas of responsibility in alignment with the organization's strategic objectives.
Work Experience
MINIMUM QUALIFICATIONS Education: Bachelor's degree in Mathematics, Actuarial Science, or a relevant field. Work Experience: Seven (7) years' Medicare, or similar actuarial analysis experience, with three (3) years' experience in leadership. Licensure: None Certification: Associate or Fellow of the Society of Actuaries (ASA or FSA) prior to start date and maintained. Membership in the American Academy of Actuaries (MAAA) prior to start date and maintained. Skills/Knowledge/Abilities: Qualified to certify the Medicare Advantage Bid. Knowledge of the Medicare Advantage Bid process and applicable regulations. In-depth understanding of Medicare Advantage revenue systems and strategies. Possess an understanding of Health First Health Plans product offerings. Knowledge of medical benefits, provider reimbursement methodologies, medical and dental terminology, claim adjudication and benefit plan application for Point of Service, HMO, PPO or Medicare plans. Conveys knowledge to others. Ability to communicate highly complex information verbally and in written form which may include strategic plans and projects. Ability to collaborate and interact with staff, internal management, external executive management, providers and external partners. Design, develop and implement highly complex programs, products, technical systems and overall policies in accordance with Health First's strategy. Readily accepts change and influences organizational change to meet strategic goals of Health First. SQL, SAS, and VBA programming languages.
PHYSICAL REQUIREMENTS Majority of time involves sitting or standing; occasional walking, bending, and stooping. Long periods of computer time or at workstation. Light work that may include lifting or moving objects up to 20 pounds with or without assistance. May be exposed to inside environments with varied temperatures, air quality, lighting and/or low to moderate noise. Communicating with others to exchange information. Visual acuity and hand-eye coordination to perform tasks. Workspace may vary from open to confined. May require travel to various facilities within and beyond county perimeter; may require use of personal vehicle.
Benefits
ABOUT HEALTH FIRST
At Health First, diversity and inclusion are essential for our continued growth and evolution. Working together, we strive to build and nurture a culture that recognizes, encourages, and respects the diverse voices of our associates. We know through experience that different ideas, perspectives, and backgrounds create a stronger and more collaborative work environment that delivers better results. As an organization, it fuels our innovation and connects us closer to our associates, customers, and the communities we serve.
Schedule :
Full-Time
Shift Times :
800am_500pm
Paygrade :
EDR