What are the responsibilities and job description for the Director of Actuarial Services position at CommuniCare Health Services?
PURPOSE/BELIEF STATEMENT
Actuarial Services support is an important function within the organization. The Director of Actuarial Services provides support to two health plans CommuniCare Advantage and West Virginia Senior Advantage. Will also provide support to the ACO Reach organization. Builds tools and provides analysis and recommendations for bid pricing, benefit design, service area expansion, claims reserves, partnerships and other estimates as required. This position will report to the CFO and work closely with Analysts, Accountants, and Data Architects.
Job Duties & Responsibilities
Actuarial Services support is an important function within the organization. The Director of Actuarial Services provides support to two health plans CommuniCare Advantage and West Virginia Senior Advantage. Will also provide support to the ACO Reach organization. Builds tools and provides analysis and recommendations for bid pricing, benefit design, service area expansion, claims reserves, partnerships and other estimates as required. This position will report to the CFO and work closely with Analysts, Accountants, and Data Architects.
Job Duties & Responsibilities
- Build and maintain databases and reports relevant to claims analytics and benefit pricing an utilization.
- Model and analyze performance through reports and dashboards
- Prepare statements and reports for presentation to Board of Directors
- Work closely with internal team and external actuary contract support for bid completion and statement of actuarial opinion for annual filings.
- Applies expert knowledge and modeling to create new and improve existing processes.
- Assists with reserve analysis
- A bachelor degree in Mathematics, Actuarial Science or related field and 5-10 yrs of actuarial experience, preferably in a healthcare insurance environment.
- Familiarity with CMS bid process and benefit design preferred
- Experience in Medicare or Medicaid program preferred, Managed Care experience highly desired.
- Must be knowledgeable in advanced modeling and presenting complex data in simple formats.
- Must have the ability to make independent decisions when circumstances warrant
- Must be able to deal tactfully with team members and managers
- Excellent Excel skills are required, database mining and reporting desired.
- Superior organizational skills, strong task management skills and the ability to prioritize tasks.
- Also important are excellent interpersonal and communication skills with both internal and external customers, and the ability to work in a team oriented environment.
- A positive attitude, with a high degree of ethics and personal integrity, as well as confidentiality, are traits needed to be successful in this role.
