Position Summary:
The Actuarial Manager, Models and Tools will lead a team of analysts supporting the models and tools used for forecasting revenue and claims in the MA, ACO REACH, and MSSP populations. They will help to create standardized reporting of results at the national and market levels. The Actuarial Manager will set claims completion factors and oversee RAF accrual projections for national payers. Manager will collaborate with market teams to inform national estimates and communicate results to senior leadership.
Essential Job Functions:
•Lead and support a team of analysts developing actuarial models and tools
•Drive enhancements to Medical Margin models
•Develop standardized reporting of close results at both the market and national level
•Evaluate/set claims completion factors quarterly for national payers
•Collaborate with actuarial market teams to identify changes in national claims trends and drivers of prior period development
•Oversee RAF accrual estimates and annual risk adjustment budgets
•Inform revenue projections for ACO REACH and MSSP populations
•Partner with market teams in delivery of monthly close results to senior leadership
•Support build-out of improved actuarial team processes
•Review internal/external audit documentation
Other Job Functions:
•Grow and lead talent
•Exemplify companies’ core values
•Collaborate with Market Finance, FP&A, Accounting, Med Econ, and others
Required Qualifications:
1.Minimum Experience
•5+ years of actuarial experience
•Demonstrated leadership capability, has previously led others
2.Education/Licensure
•ASA or FSA designation
•Bachelor’s degree in Actuarial Science, Math, Economics or related field
Knowledge, Skills, and Abilities:
•Excellent communication, both written and verbal
•Understanding of health plan and CMS provided data (membership, claims, revenue) and reports
•Experience with reserving and risk adjustment
•Experience with value-based arrangements is a plus
•Proficiency with Excel and SQL
•Strong model building mindset; model flow, ease of use, auditability, etc.
•Proven ability to work in a fast-paced environment where internal/external client satisfaction is key
•Experience presenting actuarial/financial concepts to a non-technical audience
•Proven problem-solving skills (identification of issue, causes, solution, implementation plan)
•Proven ability to influence, grow, and motivate others
•Entrepreneurial and innovative spirit
Salary range shown is a guideline. Individual compensation packages can vary based on factors unique to each candidate, such as skill set, experience, and qualifications.
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