Chief Actuary

The Chief Actuary is responsible for finding solutions to balance costs and risks, conducting regular rate, RX and administration analysis, researching and pricing products, and the financial impacts relating to product development. The Chief Actuary is responsible for developing the organization's Health Plan premium rate structures, through regular and systematic analysis, and forecasting of financial / statistical data in a manner that is actuarially sound, competitive, and that provides margin in accordance with organizational goals and objectives. In performing this role, this position oversees the rate filing processes, which includes both internal analysis and external coordination and collaboration with consultants and regulatory officials, including the Department of Insurance. The Health Plans business includes Commercial Large Group and ACA Small Group & Individual / Merged Market, Medicaid, and Medicare. This position is also responsible for leading the development of risk-sharing budgets and trends, the Large Group Underwriting Bank Account development and monitoring, and other related analytic work and financial control processes. Key customers include ELT, Sales, Network, Medical Management, and Underwriting leaders. In addition, this position will work closely with the legal department to identify, size, and communicate financial risks and opportunities related to legislative and regulatory changes, including impacts to premiums, benefits, and product designs. The candidate is required to be comfortable both within and outside of the traditional actuarial discipline to broaden his or her sphere of influence. It is crucial to be able to prioritize work for maximum impact while keeping all constituents motivated and engaged.

Essential Functions :

• Leads the development of trends and other components of rate filings across all applicable product lines. Work collaboratively with key internal stakeholders and external consultants. Lead the follow-up analysis, and research / answer all inquiries from the DOI and other regulatory agencies as necessary
• Provides financial and analytic support for the annual Medicare Bid process, the Medicare Supplement business and maintenance of EGWP rating models and pricing, and trend analytics, including :

Medicare Advantage bid development – benefit change valuation and bid form creation support in collaboration with external actuarial firm

Medicare Advantage program evaluation – examine the impact of programs designed to manage cost, product / geographic performance, and expansion opportunities

Annually, the Medicaid rate packet development. Examines methodologies, analyzes historical data and projects future claims expense to assist in advocacy for adequate rates from the Executive Office of Health and Human Services (EOHHS)

Medicaid clinical program evaluations. Develops methods to analyze the impact of clinical programs designed to control medical costs and resultant trend

Minimum Requirements :

Bachelor’s degree in Business, Finance, or related field (Master’s degree preferred) with a minimum of 10 years of experience performing advanced health care analysis, or an equivalent combination of education and experience. Society of Actuaries (FSA) required. MBA preferred.

Working Conditions : Works in a standard office-based environment; non-standard hours are a common occurrence.

Supervisory Responsibilities :

Direct :

Actuarial and Analytics Manager

Acknowledgement : By signing below, I acknowledge that I have reviewed this role description and understand the key accountabilities of my role. I am able to perform the essential functions as outlined with or without reasonable accommodation. I understand that from time to time, I may be asked to perform duties and handle responsibilities that are not specifically addressed in my job description. I have discussed any questions about this job description with my immediate supervisor or member of the HR staff prior to signing this form.