Director Actuarial Services I

Univera Healthcare•Rochester, NY

About The Position

Summary: The Dir Actuarial Service is responsible for supervision of staff in the routine operation of the Actuarial Services departments. This position leads healthcare cost trend and medical cost analysis, and financial forecasting and budgeting process for the health plan. The Director develops and provides actuarial and financial recommendations that protect the organization’s financial integrity; information and recommendations provided must be sound and consistent to support target pricing margins, corporate goals, new initiatives and other complex measures related to financial solvency. The incumbent plays an active role in the preparation and interpretation of data and related formulae. The position utilizes national and local information sources ranging from industry publications and consultants to analysis of internal data and works effectively with a wide variety of internal staff, external vendors, and regulators. Essential Primary Responsibilities/Accountabilities: Builds new quarterly trend and forecasting process in collaboration with Health Care Network Management staff. Develops quarterly health plan financial forecast and necessary monthly analyses. Develops health plan financial budget. Coordinates financial forecast and budget development for all lines of business. Develops dental Reporting, small group pricing, and rate filings. Forecasts health plan margin strategy requirements. Trends model development and maintenance. Conducts trend analysis to support pricing, forecasting, and opportunity identification. Conducts Monthly Stop Loss reserve analysis and support. Develops seasonality analyses. Designs, implements and maintains medical expense trend models including cross-functional collaboration and information sharing. Ensures efficient use of SAS software in the development of data sets and models. Develops and maintains appropriate level of SAS expertise in the department. Identifies and manages departmental goals consistent with corporate objectives. Establishes individual annual performance goals for staff, guide staff in setting individual learning and development plans, assess individual performance, and determine merit, promotional and recognition salary increases and awards. Ensures efficient management of the department; promote continual process improvement. Mentors and develop staff to take leadership roles. Ensures consistent policies and procedures across regions. Takes a leadership role in representing the department on special projects. Identifies emerging issues that impact corporate, divisional or departmental goals. Notifies Information Management with regards to Data Warehouse integrity issues. Prepares and maintain documentation for routine procedures and special projects. Consistently demonstrates high standards of integrity by supporting the Lifetime Healthcare Companies’ mission and values and adhering to the Corporate Code of Conduct and leading to the Lifetime Way values and beliefs. Maintains high regard for member privacy in accordance with the corporate privacy policies and procedures. Maintains knowledge of all relevant legislative and regulatory mandates and ensures that all activities are in compliance with these requirements. Conducts periodic staff meetings to include timely distribution and education related to departmental and Ethics/Compliance information. Regular and reliable attendance is expected and required. Performs other functions as assigned by management.

Requirements

Bachelor’s degree in Actuarial Science, Mathematics, Statistics or related field and eight years actuarial experience in a healthcare environment.
Minimum three years of experience in leadership role.
Advanced analytical skills.
Advanced knowledge of financial and risk arrangements.
Strong PC skills and proficiency in Microsoft Office.
Strong verbal and written communication skills.
Strong project and people management skills.
Strong leadership skills.
Ability to translate technical concepts into business language.
Ability to design and implement process improvements.
High integrity and interpersonal skills.
High sense of urgency and accountability.
High degree of independence, creativity and initiative.

Nice To Haves

Professional designations of Fellow of the Society of Actuaries and Member of the American Academy of Actuaries (MAAA) preferred.
Minimum of five years of experience in leadership role preferred.

Responsibilities

Builds new quarterly trend and forecasting process in collaboration with Health Care Network Management staff.
Develops quarterly health plan financial forecast and necessary monthly analyses.
Develops health plan financial budget.
Coordinates financial forecast and budget development for all lines of business.
Develops dental Reporting, small group pricing, and rate filings.
Forecasts health plan margin strategy requirements.
Trends model development and maintenance.
Conducts trend analysis to support pricing, forecasting, and opportunity identification.
Conducts Monthly Stop Loss reserve analysis and support.
Develops seasonality analyses.
Designs, implements and maintains medical expense trend models including cross-functional collaboration and information sharing.
Ensures efficient use of SAS software in the development of data sets and models.
Develops and maintains appropriate level of SAS expertise in the department.
Identifies and manages departmental goals consistent with corporate objectives.
Establishes individual annual performance goals for staff, guide staff in setting individual learning and development plans, assess individual performance, and determine merit, promotional and recognition salary increases and awards.
Ensures efficient management of the department; promote continual process improvement.
Mentors and develop staff to take leadership roles.
Ensures consistent policies and procedures across regions.
Takes a leadership role in representing the department on special projects.
Identifies emerging issues that impact corporate, divisional or departmental goals.
Notifies Information Management with regards to Data Warehouse integrity issues.
Prepares and maintain documentation for routine procedures and special projects.
Consistently demonstrates high standards of integrity by supporting the Lifetime Healthcare Companies’ mission and values and adhering to the Corporate Code of Conduct and leading to the Lifetime Way values and beliefs.
Maintains high regard for member privacy in accordance with the corporate privacy policies and procedures.
Maintains knowledge of all relevant legislative and regulatory mandates and ensures that all activities are in compliance with these requirements.
Conducts periodic staff meetings to include timely distribution and education related to departmental and Ethics/Compliance information.
Performs other functions as assigned by management.