Manager of Actuarial Services

Excellus BCBS•Rochester, NY

About The Position

Summary: The Manager of Actuarial Services is responsible for managing a team that preforms financial projections and actuarial analyses for complex projects in support of our organization’s diverse product portfolio. This role will oversee the development of actuarial assumptions and analysis of actuarial research to determine appropriate claim reserves and related liabilities, forecasts financial results; prepares financial reports; establishes insurance rates, rate structures, and rating systems; develops ad hoc and regulatory reports to various internal and external entities. This role ensures actuarial modeling is consistent with Actuarial Standards of Practice developed and promulgated by the Actuarial Standards Board. Essential Accountabilities: Oversees the development and maintenance of sound liability estimation methodologies. Manages recommendations for reserves for blocks of business and in total, organizes analyses to support recommendations. Leads preparation of accruals/liabilities for CMS Part D risk sharing and Part C revenue settlements. Leads preparation and submission of NYS Insurance Department quarterly and annual reports, including NAIC, NY Supplement and HMO Statements. Leads preparation and submission of Regulation 146 and Direct Pay Stop Loss reports to the NYS Insurance Department. Oversees the submission and quality of NYS and CMS regulatory encounter submissions and supports all required audits, internal and external to ensure accuracy. Leads preparation reporting, valuation, and forecasting of risk adjustment scores and revenue to support partners internal and external, including providers and vendors. Manages the development of financial plans, forecasts, and other financial projections. Prepares, or obtains externally, actuarial statements of opinion for rate and product filings and financial statements for assigned business segments. Leads preparation of Medicare Advantage bids and coordinates CMS bid review responses. Recommends regional or product line profitability targets; ensures pricing is consistent with established targets for those business segments priced in actuarial. Develops and maintains rates, rating factors and rate filings. Develops and maintains rating methods and models. Provides guidance to the Health Plan product development process. Oversees the development of competitive product and rate comparisons and analyzes competitive developments in the marketplace. Monitors developments in actuarial techniques, researches laws and regulations applicable to actuarial science and insurance operations. Provides counsel on current and proposed health plan Underwriting guidelines for commercial and Medicare eligible subgroups. Consistently demonstrates high standards of integrity by supporting the Lifetime Healthcare Companies’ mission and values, 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 compliant 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 math, economics, actuarial science, or related field required.
Seven (7) years of actuarial experience.
Prior experience supervising or managing people and/or projects or indirectly leading teams.
Advanced knowledge of financial and risk health arrangements.
Strong skills including proficiency in Microsoft Office, SAS and Cognos.
Strong verbal and written communication skills with the ability to present clear and concise information to all audiences.
Ability to design and implement process improvements.
Ability to translate technical concepts into business language.
A thorough understanding of non-Actuarial functions such as Rating & Underwriting, Finance, Provider Contracting, Network Management, Product Development, Medical Management, Marketing & Sales, etc. and how they impact Health Plan operations, financials and forecasts.
In depth understanding of Actuarial Standards of Practice developed and promulgated by Actuarial Standards Board.

Nice To Haves

Exam progression or professional credentials, such as ASA, FSA or MAAA preferred.

Responsibilities

Oversees the development and maintenance of sound liability estimation methodologies.
Manages recommendations for reserves for blocks of business and in total, organizes analyses to support recommendations.
Leads preparation of accruals/liabilities for CMS Part D risk sharing and Part C revenue settlements.
Leads preparation and submission of NYS Insurance Department quarterly and annual reports, including NAIC, NY Supplement and HMO Statements.
Leads preparation and submission of Regulation 146 and Direct Pay Stop Loss reports to the NYS Insurance Department.
Oversees the submission and quality of NYS and CMS regulatory encounter submissions and supports all required audits, internal and external to ensure accuracy.
Leads preparation reporting, valuation, and forecasting of risk adjustment scores and revenue to support partners internal and external, including providers and vendors.
Manages the development of financial plans, forecasts, and other financial projections.
Prepares, or obtains externally, actuarial statements of opinion for rate and product filings and financial statements for assigned business segments.
Leads preparation of Medicare Advantage bids and coordinates CMS bid review responses.
Recommends regional or product line profitability targets; ensures pricing is consistent with established targets for those business segments priced in actuarial.
Develops and maintains rates, rating factors and rate filings.
Develops and maintains rating methods and models.
Provides guidance to the Health Plan product development process.
Oversees the development of competitive product and rate comparisons and analyzes competitive developments in the marketplace.
Monitors developments in actuarial techniques, researches laws and regulations applicable to actuarial science and insurance operations.
Provides counsel on current and proposed health plan Underwriting guidelines for commercial and Medicare eligible subgroups.
Consistently demonstrates high standards of integrity by supporting the Lifetime Healthcare Companies’ mission and values, 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 compliant 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.