VP, Chief Medicaid Actuary

CareSource • Dayton, OH

23h • $150,000 - $300,000 • Onsite

About The Position

The Vice President, Actuarial - Product is responsible for driving company strategy and managing actuarial expertise in coordination with other leaders on all aspects of CareSource’s rate levels to ensure actuarial soundness, and to use actuarial knowledge and tools to help improve profitability of CareSource’s lines of business. This role oversees and is responsible for all actuarial aspects of rate filing and bid development, including filing strategy, benefit strategy and design, filing compliance, and manages external and internal actuarial resources and relationships involved with those functions. The position evaluates and advises on the impact of long-range planning, introduction of new programs/strategies, and regulatory actions. It also oversees the actuarial forecast process, ensuring the integrity of the data and methodology of the results and tracks changes and variances. The role proactively researches existing and new regulations/legislation and advises management of actions and potential risks, providing strategic decision-making support to market leadership on all aspects of the business including financial, clinical, operations, and product development. The VP oversees and assures the coordination, relevance, and performance of all actuarial functions in support of CareSource business needs, holding ultimate responsibility for necessary improvements and changes to keep pace with evolving business needs. Additionally, the role leads the selection and hiring of actuarial staff, and manages actuarial and other staff on a project basis for both actuarial and inter-departmental projects. It manages the continual improvement of actuarial processes and makes changes as needed to support the business. The VP represents Actuarial Services and CareSource in written and verbal communications, presentations, and meetings with regulators, owners, and other outside parties regarding matters requiring actuarial expertise. The role uses analytical understanding to provide strategic insights and recommendations to CareSource’s C-suite leadership in support of decisions related to the strategic direction of the company. It oversees and supports the alignment of Actuarial Services with the Finance Department to assure the best possible business intelligence and understanding of company financials in communications to CareSource executive leadership. The VP is responsible for decision-making and strategy regarding actuarial inputs to the monthly financial reporting process and reports, such as claim reserves/accruals, variance analysis, and actuarial contributions to Management Discussion & Analysis. The role implements and maintains actuarial processes and controls consistent with best practices to assure accurate and timely reporting and handoff of actuarial components and inputs to financial reporting. Any other job duties as requested will also be performed.

Requirements

• Bachelor of Science/Arts (BA/BS) degree in Actuarial Science, Mathematics or Finance
• A minimum of ten (10) years of experience in the Actuarial Industry
• A minimum of five (5) years of management experience is required
• A minimum of seven (7) years of experience for the actuarial function in Healthcare, including Medicaid, Commercial and/or MA business, rate negotiations, design, state and federal reporting requirements, as well as other traditional actuarial functions
• Excellent PC skills, including advanced Excel, Word and PowerPoint
• Strong analytical skills
• Strong problem solving and critical thinking skills
• Ability to articulate and defend complex ideas and strategies to non-technical audiences
• Collaborative, with the ability to effectively influence others
• Fact-based decision maker
• Experience with using a data warehouse
• Excellent oral, written and interpersonal communication skills
• Strong managerial and team-building skills, with proven track record of hiring and developing high performers
• A proven track record of achievement and integrity
• Member of the American Academy of Actuaries (MAAA) and Associate or Fellow of the Society of Actuaries (ASA or FSA) is required
• Must maintain memberships in the Society of Actuaries and the American Academy of Actuaries

Nice To Haves

• Managed care and state/federal government program experience preferred
• Experience interacting with state or federal regulators, CMS or other external regulatory or auditing entities preferred

Responsibilities

• Drive company strategy and manage actuarial expertise in coordination with other leaders on all aspects of CareSource’s rate negotiations with the State Medicaid Departments, and to use actuarial knowledge and tools to help improve profitability of CareSource’s lines of business
• Oversee and be responsible for all actuarial aspects of rate filing and bid development, including filing strategy, benefit strategy and design, filing compliance and manage external and internal actuarial resources and relationships involved with those functions
• Evaluate and advise on the impact of long-range planning, introduction of new programs/strategies, and regulatory actions
• Oversees the actuarial forecast process; ensures the integrity of the data and methodology of the results and tracks changes and variances
• Proactively researches existing and new regulations/legislation and advises management of actions and potential risks
• Provide strategic decision making support to market leadership on all aspects of the business including financial, clinical, operations, and product development.
• Oversee and assure the coordination, relevance and performance of all actuarial functions in support of CareSource business needs, and hold ultimate responsibility for necessary improvements and changes to keep pace with evolving business needs
• Lead the selection and hiring of actuarial staff, and managing actuarial and other staff on a project basis for both actuarial and inter-departmental projects
• Manage continual improvement of actuarial processes and make changes as needed to support the business
• Represent Actuarial Services and CareSource in written and verbal communications, presentations and meetings with regulators, owners and other outside parties regarding matters requiring actuarial expertise
• Use analytical understanding to provide strategic insights and recommendations to CareSource’s C-suite leadership in support of decisions related to the strategic direction of the company
• Oversee and support the alignment of Actuarial Services with Finance Department to assure the best possible business intelligence and understanding of company financials in communications to CareSource executive leadership
• Responsibility for decision making and strategy regarding actuarial inputs to the monthly financial reporting process and reports, such as claim reserves/accruals, variance analysis, actuarial contributions to Management Discussion & Analysis, etc.
• Implement and maintain actuarial processes and controls consistent with best practices to assure accurate and timely reporting and handoff of actuarial components and inputs to financial reporting.
• Perform any other job duties as requested

Benefits

• In addition to base compensation, you may qualify for a bonus tied to company and individual performance.
• We are highly invested in every employee’s total well-being and offer a substantial and comprehensive total rewards package.

What This Job Offers

• Job Type: Full-time
• Career Level: Executive