Team Leader, Actuarial Services Encounter Data

Excellus BCBS•Rochester, NY

4d•$98,297 - $176,935

About The Position

Summary: This Team Leader provides oversight of a team that provides financial projections and actuarial analyses for complex projects or assignments or staff performing the design and implementation of data structures utilizing SAS software. Initiates, organizes and analyzes actuarial research and develops actuarial assumptions. Determines 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; and participates in related activities and projects. Essential Accountabilities: Supervises direct staff projects, manages deliverables and timelines, and reviews results and delivers feedback to support business objectives and analyst development. 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. Recommends reserves for blocks of business and in total. Initiates and organizes analyses to support recommendations. Leads preparation and submission of NAIC and NYS financial blanks. Leads preparation and submission of Regulation 146 and Direct Pay Stop Loss reports to the NYS Insurance Department. Manages and develops financial plans, forecasts, and other financial projections including risk sharing, reinsurance liabilities, revenues, and Medicare bid pricing. Supervises the submission and quality of NYS and CMS regulatory encounter submissions and supports all required audits, internal and external to ensure accuracy. Supervises reporting, valuation, and forecasting of risk adjustment score and revenues to support partners internal and external, including providers and vendors. Prepares, or obtains externally, actuarial statements of opinion for rate and product filings and financial statements for assigned business segments. Recommends regional or product line profitability targets; ensure pricing is consistent with established targets for those business segments priced in actuarial. Develops and maintains rates, rating factors and rate filings. Develop and maintain rating methods and models. Monitors and analyzes trends; develop trend projections and seasonality factors. Ensures proper drug claim adjudication and reporting. Provides input into product development process. Projects risk adjustment factors, model impacts of potential payment changes. Provides revenue forecasts for pro forma and bid pricing. Manages annual loss ratio testing and reporting process. Ensures efficient use of SAS software in the development of data sets and models. Monitors budget vs. actual financial results, conduct analysis of variance, and prepare variance summary. Reconciles Data Warehouse data with corporate financials. Notifies Information Management with regard to Data Warehouse integrity issues. Identifies opportunities for automation in processes. Represents the actuarial department in meetings and communications with NYSID, CMS, BCBSA, rating agencies, consultants, customers and other external parties. Prepares and maintains documentation for routine procedures and special projects. Participates in corporate or departmental process improvement initiatives that involve designing, adjusting, and documenting work processes to ensure that predictable and replicable success is achieved through best practice. Identifies non-actuarial functional work occurring within actuarial or actuarial functional work occurring outside actuarial and initiates/supports corrective functional transition plans. Oversees the design and development of Actuarial data extracts, marts and warehouses. Proposes and assists in development of Actuarial process improvements utilizing SAS or other analytical software Consistently demonstrates high standards of integrity by supporting the Lifetime Healthcare Companies’ mission and values and adhering to the Corporate Code of Conduct. 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

Five (5) years of actuarial or related insurance industry experience.
Bachelor’s degree in math, economics, actuarial science, or related field.
Ability to understand and work with programming languages similar to SAS, SQL, R, Python, C/++/#, VB, etc.
Advanced analytical skills.
Advanced knowledge of financial and health risk arrangements.
Prior experience supervising or managing people and/or projects or indirectly leading teams.
Strong skills including proficiency in Microsoft Office, SAS, Cognos or related software.
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.
Ability to work prolonged periods sitting and/or standing at a workstation and working on a computer.
Ability to work in a home office for continuous periods of time for business continuity.

Nice To Haves

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

Responsibilities

Supervises direct staff projects, manages deliverables and timelines, and reviews results and delivers feedback to support business objectives and analyst development.
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.
Recommends reserves for blocks of business and in total.
Initiates and organizes analyses to support recommendations.
Leads preparation and submission of NAIC and NYS financial blanks.
Leads preparation and submission of Regulation 146 and Direct Pay Stop Loss reports to the NYS Insurance Department.
Manages and develops financial plans, forecasts, and other financial projections including risk sharing, reinsurance liabilities, revenues, and Medicare bid pricing.
Supervises the submission and quality of NYS and CMS regulatory encounter submissions and supports all required audits, internal and external to ensure accuracy.
Supervises reporting, valuation, and forecasting of risk adjustment score and revenues to support partners internal and external, including providers and vendors.
Prepares, or obtains externally, actuarial statements of opinion for rate and product filings and financial statements for assigned business segments.
Recommends regional or product line profitability targets; ensure pricing is consistent with established targets for those business segments priced in actuarial.
Develops and maintains rates, rating factors and rate filings.
Develop and maintain rating methods and models.
Monitors and analyzes trends; develop trend projections and seasonality factors.
Ensures proper drug claim adjudication and reporting.
Provides input into product development process.
Projects risk adjustment factors, model impacts of potential payment changes.
Provides revenue forecasts for pro forma and bid pricing.
Manages annual loss ratio testing and reporting process.
Ensures efficient use of SAS software in the development of data sets and models.
Monitors budget vs. actual financial results, conduct analysis of variance, and prepare variance summary.
Reconciles Data Warehouse data with corporate financials.
Notifies Information Management with regard to Data Warehouse integrity issues.
Identifies opportunities for automation in processes.
Represents the actuarial department in meetings and communications with NYSID, CMS, BCBSA, rating agencies, consultants, customers and other external parties.
Prepares and maintains documentation for routine procedures and special projects.
Participates in corporate or departmental process improvement initiatives that involve designing, adjusting, and documenting work processes to ensure that predictable and replicable success is achieved through best practice.
Identifies non-actuarial functional work occurring within actuarial or actuarial functional work occurring outside actuarial and initiates/supports corrective functional transition plans.
Oversees the design and development of Actuarial data extracts, marts and warehouses.
Proposes and assists in development of Actuarial process improvements utilizing SAS or other analytical software
Consistently demonstrates high standards of integrity by supporting the Lifetime Healthcare Companies’ mission and values and adhering to the Corporate Code of Conduct.
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.