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

Emory•Atlanta, GA

13h•Hybrid

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 involves building and maintaining financial operating systems, reporting processes, budget management, vendor financial controls, and regulatory compliance frameworks to support EHP's growth, governance, and fiduciary duties 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.
Residency in the state of GA.

Nice To Haves

CPA or equivalent accounting credential strongly preferred.
Master's degree in business administration, health administration, or a related field preferred.

Responsibilities

Building and sustaining 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 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.
Leading contract financial review and interpretation across all vendor and provider agreements, identifying financial risks, and ensuring alignment with budget assumptions.
Supporting senior leadership in strategic TPA, PBM, and stop-loss carrier contract negotiations with accurate financial performance data.
Owning EHP's regulatory compliance function in partnership with third-party advisors and internal leadership, maintaining compliance programs for ERISA, HIPAA, ACA, and Consolidated Appropriations Act (CAA) transparency and Mental Health Parity requirements.
Overseeing the preparation and submission of all required regulatory and state filings.
Coordinating internal and external audit processes, maintaining compliance documentation and internal controls.
Serving as a financial partner to senior leadership on actuarial and complex financial matters, including 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.
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 and contributing financial judgment.
Providing financial data inputs for stop-loss program reporting and benefits design financial modeling.
Managing and developing a team, hiring additional staff as EHP scales, and providing clear direction, professional development, and performance management.
Performing related responsibilities as required.