Director of Actuarial Services, Health Plan Services

LOCATION: Health Plan Services

Shift: 8:30AM – 4:30PM

The final salary and offer components are subject to additional approvals based on Cook County Health (CCH) policy. Your placement within the salary range is dependent on a number of factors including your work experience and internal equity within this position classification at CCH. For positions that are represented by a labor union, placement within the salary range will be guided by the rules in the collective bargaining agreement.

This position is exempt from Career Service under the CCH Personnel Rules.

Job Summary

The Director Actuarial Services, Health Plan Services will lead, manage, and coordinate the analytical efforts supporting the rate setting process for CountyCare and Medicare programs to ensure rates are competitive, adequate, and actuarially sound. Serves as a subject matter expert and trusted advisor for health plan leadership. The Director will be responsible performing duties that include, but not limited to, competitive analysis, network analysis, risk adjustment, analyzing trends, actuarial benefit value analysis, etc. and determining the implications on premiums, risk adjustment, and strategic initiatives.

General Administrative Responsibilities

Collective Bargaining

• Review applicable Collective Bargaining Agreements and consult with Labor Relations to generate management proposals
• Participate in collective bargaining negotiations, caucus discussions and working meetings

Discipline

• Document, recommend and effectuate discipline at all levels
• Work closely with labor relations and/or labor counsel to effectuate and enforce applicable Collective Bargaining Agreements
• Initiate, authorize and complete disciplinary action pursuant to CCH system rules, policies, procedures and provision of applicable collective bargaining agreements

Supervision

• Direct and effectuate CCH management policies and practices
• Access and proficiently navigate CCH records system to obtain and review information necessary to execute provisions of applicable collective bargaining agreements

Management

• Contribute to the management of CCH staff and CCH’ systemic development and success
• Discuss and develop CCH system policies and procedures
• Consistently use independent judgment to identify operational staffing issues and needs and perform the following functions as necessary; hire, transfer, suspend, layoff, recall, promote, discharge, assign, direct or discipline employees pursuant to applicable Collective Bargaining Agreements
• Work with Labor Relations to discern past practice when necessary

Typical Duties

• Serves as a subject matter expect overseeing all aspects of the rate setting process.
• Collects and analyzes claim and membership data to estimate potential liabilities.
• Leads and manages the risk adjustment processes and operations
• Develops and projects actuarial models.
• Assists in the development of financial forecasts and projections including the identification of risks and opportunities.
• Provides insight and support for the reinsurance placement process.
• Recognizes and prepares opportunities to enhance analyses and improve efficiencies.
• Develops reserves and submits the documents for the incurred but not reported (IBNR) reporting.
• Reviews and analyzes regulations and potential impacts on the health plan.
• Prepares and submits all required state and regulatory report filings
• Supports medical economics and network pricing analysis by participating in contract negotiations focusing on strategic the rate setting process that will be implemented with Medicaid.
• Assists in the development of the Medicare bid.
• Performs all functions according to established policies, procedures, regulatory and accreditation requirements, as well as applicable professional standards.
• Attends and participates in meetings, groups discussions, and committees as required.
• Reports to the Chief Financial Officer, Health Plan Services.
• Performs other duties as assigned.

Minimum Qualifications

• Bachelor’s degree in Actuarial Science, Economics, Mathematics, Applied Statistics or related field from an accredited college or university is required (Copy of official transcripts due at the time of interview)
• Credential in one of the following: Associate of Society of Actuaries (ASA) or Fellows of the Society of Actuaries (FSA) designation or Chartered Enterprise Risk Analyst (CERA) is required
• Four (4) years of actuarial experience is required
• Three (3) years of supervising and/or managing staff is required
• Prior actuarial experience in health care developing program rates and pricing methodologies for Medicaid and Medicare is required
• Proficiency in Microsoft Office Excel is required

Preferred Qualifications

• Master’s degree from an accredited college or university is preferred (Copy of official transcripts due at the time of interview)
• Prior experience in a leadership role within a Medicaid and Medicare health plan is preferred
• Proficiency with SAS and/or SQL is preferred

Knowledge ,Skills, Abilities and Other Characteristics

• Knowledge and understanding of bid preparation for the Medicare Bid
• Excellent verbal and written communication skills necessary to communicate with all levels of staff and a patient population composed of diverse cultures and age groups.
• Demonstrate attention to detail, accuracy and precision
• Demonstrate analytical and organizational, problem-solving, critical thinking and conflict management/resolution skills
• Ability to maintain a professional demeanor and composure when challenged.
• Ability to prioritize, plan and organize projects and tasks.

VETERAN PREFERENCE

PLEASE READ

When applying for employment with the Cook County Health & Hospitals System, preference is given to honorably discharged Veterans who have served in the Armed Forces of the United States for not less than 6 months of continuous service

To take advantage of this preference a Veteran must:

• Meet the minimum qualifications for the position.

• Identify self as a Veteran on the employment application by answering yes to the question by answering yes to the question, “Are you a Military Veteran?”

• Attach a copy of their DD 214, DD 215 or NGB 22 (Notice of Separation at time of application filing. Please note: If you have multiple DD214s, 215s, or NGB 22S, Please submit the one with the latest date. Coast Guard must submit a certified copy of the military separation from either the Department of Transportation (Before 9/11) or the Department of Homeland Security (After 9/11). Discharge papers must list and Honorable Discharge Status. Discharge papers not listing an Honorable Discharge Status are not acceptable

OR

A copy of a valid State ID Card or Driver’s License which identifies the holder of the ID as a Veteran, may also be attached to the application at time of filing.

If items are not attached, you will not be eligible for Veteran Preference

VETERANS MUST PROVIDE ORIGINAL APPLICABLE DISCHARGE PAPERS OR APPLICABLE STATE ID CARD OR DRIVER’S LICENSE AT TIME OF INTERVIEW.

MUST MEET ALL REQUIRED QUALIFICATIONS AT TIME OF APPLICATION FILING.

BENEFITS PACKAGE

• Medical, Dental, and Vision Coverage
• Basic Term Life Insurance
• Pension Plan
• Deferred Compensation Program
• Paid Holidays, Vacation, and Sick Time
• You may also qualify for the Public Service Loan Forgiveness Program (PSLF)
• 100% Tuition Reimbursement for nursing-related programs

For further information on our excellent benefits package, please click on the following link: http://www.cookcountyrisk.com/

*Degrees awarded outside of the United States with the exception of those awarded in one of the United States’ territories and Canada must be credentialed by an approved U. S. credential evaluation service belonging to the National Association of Credential Evaluation Services (NACES) or the Association of International Credential Evaluators (AICE). Original credentialing documents bust be presented at time of interview.

• Please note all offers of Employment are contingent upon the following conditions: satisfactory professional & employment references, healthcare and criminal background checks, appropriate licensure/certifications and the successful completion of a physical and pre-employment drug screen.

• CCHHS is strictly prohibited from conditioning, basing or knowingly prejudicing or affecting any term or aspect of County employment or hiring upon or because of any political reason or factor.

COOK COUNTY HEALTH & HOSPITALS SYSTEM IS AN EQUAL OPPORTUNITY EMPLOYER