Senior Director, Financial Operations and Actuarial Strategy - Emory Health Plan

Emory University•Atlanta, GA

About The Position

The Senior Director, Financial Operations and Actuarial Strategy is responsible for the financial infrastructure, controls, and operational oversight necessary for the sound financial management of Emory Health Plan's (EHP) medical, pharmacy, and administrative costs. This role is crucial for enabling EHP's growth, governance, and fiduciary obligations as a large self-funded health plan.

Requirements

Bachelor's degree in accounting, finance, health administration, business administration, or a related field.
9+ years of progressive experience in health plan finance, managed care finance, or related healthcare financial operations.
Demonstrated depth in financial controls, reporting, and accounting.
CPA or equivalent accounting credential strongly preferred.
Master's degree in business administration, health administration, or a related field preferred.

Responsibilities

Building and sustaining the financial operating systems, reporting cadences, budget processes, vendor financial controls, and regulatory compliance frameworks.
Owning EHP's vendor financial management function, including managing and directing the execution of Third Party Administrator (TPA) and Pharmacy Benefits Manager (PBM) invoice reconciliation, payment accuracy controls, and payment integrity oversight.
Overseeing the financial performance of key vendors, tracking contract compliance, unit cost trends, and administrative fee performance against contractual terms.
Leading contract financial review and interpretation across all vendor and provider agreements, flagging financial risk and ensuring alignment with budget assumptions.
Supporting senior leadership in strategic TPA, PBM, and stop-loss carrier contract negotiations with accurate, current financial performance data.
Owning EHP's regulatory compliance function in partnership with third-party compliance advisors and internal legal and compliance leadership.
Maintaining EHP's compliance program for applicable self-funded plan regulations, including ERISA, HIPAA, ACA, and the Consolidated Appropriations Act (CAA) transparency and Mental Health Parity requirements.
Overseeing the preparation and timely submission of all required regulatory filings and any applicable state filings.
Coordinating internal and external audit processes, maintaining compliance documentation and internal controls, and building toward direct regulatory expertise.
Serving as an informed financial partner to senior leadership on actuarial and complex financial matters, including incurred but not reported (IBNR) reserve management, claims lag analysis, and pharmacy rebate accounting.
Developing and maintaining EHP's IBNR reserve reporting and reconciliation process, validating lag assumptions and reserve estimates against the plan's reserve fund.
Owning the accounting methodology for pharmacy rebate accruals, claims runout, and other complex reserve items.
Participating in the annual rate-setting and pricing process, providing financial data inputs, grounding actuarial assumptions in operational and claims experience, and contributing informed financial judgment to the pricing analysis.
Providing financial data inputs for stop-loss program reporting and benefits design financial modeling.
Managing and developing a team, and, as EHP scales, hiring and directing additional staff to support reserve, compliance, and senior leadership modeling needs.
Providing clear direction, professional development, and performance management for all direct reports.
Performing related responsibilities as required.