AVP, Actuary-Government Business

Emblem Health • New York, NY

142d • $162,000 - $302,400 • Hybrid

About The Position

The position involves overseeing the development of pricing models and their application in product strategy for Medicare and State-Sponsored Programs (SSP). The role includes leading the Enterprise Government Actuarial Areas, which encompasses 400,000-500,000 lives and generates over $2.5 billion in revenue. The individual will be a key influencer and driver of Medicare and SSP strategy, responsible for Enterprise Medicare bid filings, Employer Group medical pricing, Medicare Supplement Pricing, SSP Premium analytics, budgeting, reporting, and financial performance tracking. Additionally, the role supports the risk adjustment team by forecasting revenue, monitoring activities, and reporting.

Requirements

• Bachelor's degree in Actuarial Science, Mathematics, Economics, or similar major.
• Fellow of the Society of Actuaries strongly preferred.
• 15+ years of actuarial experience with ASA; or 12+ years' experience with FSA.
• 10+ years health insurance actuarial experience, preferably in Medicare.
• Ability to analyze complex health insurance issues such as risk modeling, impact of provider contracting changes, etc.
• Strong understanding of actuarial principles & methodologies related to Medicare Advantage pricing and product design.
• Understanding of government benefits and design.
• Proven track record of successfully overseeing multiple large (company/divisional) projects.
• Strong organizational skills and ability to prioritize and successfully manage multiple priorities/deadlines.
• Strong management and leadership skills - ability to develop and motivate staff.
• Excellent written and verbal communicator - need to be able to summarize complex analyses succinctly and be able to present results to senior management and others effectively.
• Executive presence; comfortable speaking with all organizational levels, within and external to, the company.
• Proficient with MS Office (Word, Excel, Access, PowerPoint, Outlook).

Responsibilities

• Support and influence multi-year strategy development for Government business.
• Responsible for development and accuracy of Medicare pricing/budget assumptions in support of strategy, including new and existing Medicare plans.
• Support management of segment action plans to achieve margin targets.
• Responsible for the oversight of the filing of Medicare Advantage bids.
• Oversee development and filing of premium rates for all products with the appropriate regulatory authority (e.g., CMS, New York Department of Health).
• Manage and develop a high-performing Actuarial team.
• Monitor progress on individual goals, provide support on individual development plans, and proactively plan for growth and succession.
• Manage analysis of underlying business performance for Government business lines.
• Fulfill SSP filing requirements defined by regulatory entities such as SCMS and DOH.
• Collaborate with segment leadership, Finance, HCE, and other teams to develop accurate forecasts.
• Design & develop standard reports to meet the needs of government programs and other leaders.
• Key point of contact for enterprise government plan analytics.
• Anticipate and identify key source information to analyze problems clearly, identify root causes, trends and opportunities, determine creative solutions.
• Provide support to Medicare Product and Account Management areas through analyzing and improving financial performance, including risk adjustment coding accuracy to achieve targeted profitability.

What This Job Offers

• Job Type: Full-time
• Industry: Ambulatory Health Care Services
• Education Level: Bachelor's degree
• Number of Employees: 1,001-5,000 employees