Leads the actuarial aspects of Medicare Advantage bid process, ensuring accuracy, compliance and strategic alignment with organizational goals.

$137,800.00 - $183,800.00 Annual

What We Provide

What You Will Do

• Leads the development and execution of the actuarial aspects of Medicare Advantage (MA) bids, including actuarial assumptions, modeling and forecasting.
• Collaborates with cross-functional teams to develop bid packages that align with business objectives and regulatory guidelines. Ensures accurate and compliant submissions and facilitate successful bid approvals.
• Communicates actuarial findings, assumptions, and recommendations to internal and external MA stakeholders.
• Analyzes and validates data relevant to bid submissions. Reconcile bid data with reported financials to ensure data integrity and accuracy.
• Establishes actuarial frameworks and optimize processes to efficiently interpret MA data, enabling timely and accurate decision-making.
• Provides data and analytical support to Risk Adjustment team, Care Management and other related teams to optimize revenue and manage medical expenses.
• Tracks financial performance of MA products and monitor emerging experience and trends.
• Collaborates closely with reserving actuaries to develop IBNR reserves for MA products.
• Provides guidance and assistance to Accounting department in establishing accruals related to MA.
• Collaborates with internal and external partners to identify MA growth opportunities.
• Identifies business needs and requirement for MA vendor partnerships. Track and evaluate vendor performance and alignment with growth goals.
• Conducts long term projection and ROI analysis for launching new products, expanding into new markets and optimizing existing portfolio.
• Serves as a subject matter expert on actuarial matters related to MA, offering mentorship and training to junior actuarial staff.
• Performs all duties inherent in a supervisory role. Ensures effective staff training, interviews candidates for
• employment, evaluates staff performance, and recommends hiring, promotions, salary actions, and
• terminations as appropriate.
• Participates in special projects and performs other duties as assigned.

Licenses and Certifications:

• Associate of the Society of Actuaries (ASA) designation preferred
• Member of the American Academy of Actuaries (MAAA) preferred

Education:

• Bachelor's Degree in Mathematics, Actuarial Science, Statistics or equivalent work experience required

Work Experience:

• Minimum five years of progressively responsible actuarial experience in a Health Plan/ Managed Care organization or similar environment required
• Minimum two years experience specially related to Medicare Advantage bidding required
• Knowledge of core health actuarial processes including Pricing, Valuation, and Budgeting/Forecasting preferred
• Efficiency in manipulating and analyzing large and complex data sets from multiple sources using SAS. Proficient in MS Excel spreadsheets and Visual Basic. Knowledge of Pytho preferred
• Ability to multi-task required
• Prior experience communicate quantitative analyses and results in a clear, precise and actionable manner preferred