Director, Actuarial Services, Medicaid

Job ID: J116697
Company: Gateway Health Plan
Location: Pittsburgh, PA, United States
Full/Part Time: Full time
Job Type: Regular
Posted at: Feb 16, 2018

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Description

JOB SUMMARY

This job is responsible for the overall management and technical oversight of an actuarial staff (fellows, associates, actuarial candidates, and/or support personnel) where activities are concerned with pricing and rate development; overseeing assigned actuarial staff and projects and developing and implementing sound actuarial policies and practices to help the Organization meet its financial objectives; providing technical support for other areas such as Product Management & Development, Underwriting & Rating, and Sales.

ESSENTIAL RESPONSIBILITIES

  • Manage all levels of Actuarial staff.
  • Oversee the Medicare Advantage bids.
  • Rate negotiations with state Medicaid agencies.
  • Work Risk Adjustment, Decision Support, Financial Planning, Sales and Product Management and Development to develop and implement appropriate business strategies.
  • Provide advanced support for the claim reserve process.
  • Provide assistance and risk management to the Product Management and Development area for pricing development of new products. Ensure that all new products are financially viable and stable.
  • Determine underlying factors impacting pure premium trends for various products and regions. Monitor trends for use in rating, bids and rate negotiations. Identify any shifts in trend and take appropriate pricing actions.
  • Other duties as assigned or requested.

EDUCATION

Minimum

  • Bachelor's Degree
  • 10 years of experience in the actuarial or related field
  • 5 years of management experience and/or experience leading teams and/or projects of varying size and complexity
  • Attainment of the ASA (Associate) designation in the Society of Actuaries
  • Must be committed to pursuing actuarial exams and obtaining Fellowship in the Society of Actuaries
  • Member of the American Academy of Actuaries (MAAA)

Substitutions

  • None

Preferred

  • Bachelor’s degree in Actuarial Science, Mathematics, or Statistics

EXPERIENCE

Minimum

  • 10 years of experience in the actuarial or related field to include 5 years of management experience and/or experience leading teams and/or projects of varying size and complexity
  • Attainment of the ASA (Associate) designation in the Society of Actuaries
  • Must be committed to pursuing actuarial exams and obtaining Fellowship in the Society of Actuaries
  • Member of the American Academy of Actuaries (MAAA)

Preferred

  • 13 or more years of actuarial experience
  • FSA

SKILLS

  • Ability to apply extensive knowledge of actuarial methods and procedures
  • Strong supervisory, communication, organization and project management skills
  • Demonstrated knowledge of the following actuarial proficiencies:In-depth knowledge of one or more of the following: premium rate calculations, required reserves, plan design, trend analysis, rate table construction, Medicare Advantage bids, Medicaid rate setting and rate negotiations, actuarial research, or systems development.

SCOPE OF RESPONSIBILITY

Does this role supervise/manage other employees?        

Yes

WORK ENVIRONMENT

Is Travel Required?

No  

Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job.

Compliance Requirement: This position adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies

Employee Referral Level 4

Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities, and prohibit discrimination against all individuals based on their race, color, religion, sex, national origin, sexual orientation/gender identity or any other category protected by applicable federal, state or local law. Highmark Health and its affiliates take affirmative action to employ and advance in employment individuals without regard to race, color, religion, sex, national origin, sexual orientation/gender identity, protected veteran status or disability.
EEO is The Law
Equal Opportunity Employer Minorities/Women/ProtectedVeterans/Disabled/Sexual Orientation/Gender Identity (http://www1.eeoc.gov/employers/upload/eeoc_self_print_poster.pdf)
We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact number below.
For accommodation requests, please call HR Services at 844-242-HR4U or visit HR Services Online at HRServices@highmarkhealth.org

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