Actuary, Risk and Compliance

Humana

2d • $129,300 - $177,800 • Remote

About The Position

The Lead Actuary, Risk and Compliance is responsible for the overall management and oversight of actuaries and/or support staff where activities are concerned with identifying and managing risks. You will identify and analyze potential risks and estimates the potential financial consequences, develop and recommend controls and cost-effective approaches to minimize risks. You will work on problems of diverse scope and complexity ranging from moderate to substantial.

The Lead Actuary, Risk and Compliance will report to the Director, Actuarial Risk & Compliance. In this specific role, you will be part of a team tasked with assessment of risk, opportunities, and mitigation strategies to assure the compliant submission of bids to support Humana's pricing and product development of Medicare Advantage and Prescription Drug Plans that positively impact the financial performance of Humana. In particular, this position is responsible for ensuring compliance with CMS requirements related to Total Beneficiary Cost. This includes maintaining the internal version of the Out-of-Pocket Cost (OOPC) Model published by CMS, obtaining needed inputs from business partners, running and interpreting the model’s results, and partnering with the pricing actuaries to find solutions to resolving test failures.

In addition, as a member of the Compliance team this role is responsible for:
Supporting Humana’s MA-PD and PDP bid filings by ensuring appropriate interpretation and implementation of CMS guidance, and implementation and execution of review standards and controls to minimize compliance risk associated with the bid filing
Participate in CMS audits and reviews related to Humana’s Medicare bids.
Create and maintain process improvements to bid filings to continually improve Humana's ability to file compliant bids.
This position comes with the opportunity of leading a direct report.
The Lead Actuary, Risk and Compliance assesses and communicates information regarding actuarial/business risks across the organization. You will provide peer review and counsel on a wide variety of company, industry, and regulatory practices. Activities may include monitoring developments in actuarial techniques, and researching laws and regulations applicable to actuarial science and insurance operations. You will advise executives to develop functional strategies (often segment specific) on matters of significance.

Requirements

• Bachelor's degree
• 8 or more years of technical experience
• 2 or more years of project leadership experience
• Associate or Fellow in the Society of Actuaries (ASA or FSA)
• Member of the American Academy of Actuaries (MAAA)
• Demonstrated ability to articulate ideas effectively in both written and oral forms

Nice To Haves

• Medicare Advantage experience
• Ability to manage large projects involving actuarial and non-actuarial staff

Responsibilities

• Overall management and oversight of actuaries and/or support staff concerned with identifying and managing risks.
• Identify and analyze potential risks and estimate potential financial consequences.
• Develop and recommend controls and cost-effective approaches to minimize risks.
• Assess risk, opportunities, and mitigation strategies to assure compliant submission of bids for Humana's pricing and product development of Medicare Advantage and Prescription Drug Plans.
• Ensure compliance with CMS requirements related to Total Beneficiary Cost, including maintaining the internal version of the Out-of-Pocket Cost (OOPC) Model.
• Obtain needed inputs from business partners, run and interpret the model’s results, and partner with pricing actuaries to resolve test failures.
• Support MA-PD and PDP bid filings by ensuring appropriate interpretation and implementation of CMS guidance.
• Implement and execute review standards and controls to minimize compliance risk associated with bid filings.
• Participate in CMS audits and reviews related to Humana’s Medicare bids.
• Create and maintain process improvements for bid filings.
• Assess and communicate information regarding actuarial/business risks across the organization.
• Provide peer review and counsel on company, industry, and regulatory practices.
• Monitor developments in actuarial techniques.
• Research laws and regulations applicable to actuarial science and insurance operations.
• Advise executives to develop functional strategies on matters of significance.

Benefits

• medical
• dental
• vision benefits
• 401(k) retirement savings plan
• time off (including paid time off, company and personal holidays, paid parental and caregiver leave)
• short-term and long-term disability
• life insurance

What This Job Offers

• Job Type: Full-time
• Career Level: Senior