Our Healthcare Insurance client is seeking a Manager-Actuary to join their team for a contract role!
Our client has more than 5,000 employees and is the number 1 health insurer in the state of North Carolina serving more than 3.89 million customers.
Health care is changing, and our client is leading the way by provide innovative solutions that simplify the health care system, improve efficiency and outcomes, and help rein in costs. Our client is a not-for-profit with headquarters in Durham, NC.
Term: 6 Months, possible contract to hire
- Represents the reserving function to the Chief Actuary and Chief Financial Officer related to the accruals estimated by the Specialty Reserving team.
- Lead staff in the development and maintenance of estimates and models to accrue for relevant actuarial liabilities and assets. Determine the correct amounts to book on a monthly basis, for each of the following: ACA Risk Adjustment (and associated programs), Medicare Risk Adjustment (Part C and Part D), Value-based provider payments (Accountable Care Organizations, and other arrangements).
- Lead staff in completion and reconciliations related to rate filings for billing self-funded groups and inter-plan arrangements related to value contracts.
- Establish an enterprise network of operational, medical, and financial contacts for data to ensure accurate determination of accruals. Coordinates closely with Risk and Value actuarial teams to ensure assumptions and contract terms are current, and stays aware of regulatory updates that would impact accruals.
- Leads staff in maintenance of control documentation and support the Valuation Director and Chief Actuary in their control responsibilities related to Risk and Value.
- Works closely with Accounting to ensure that actuarial liabilities and assets are appropriately represented in the general ledger and financial statements.
- Lead staff through completion of technical projects, ensuring timeliness, compliance, and quality of work
- Proactive and strategic thought leadership of ways to improve processes, reduce risks, and meet department and enterprise objectives to achieve profitable growth and/or improve value, quality, and access for client customers
- Achieve segment financial targets and provide concise explanations of results and variances to expectations; act as a financial steward for the company
- Communicate effectively with all levels and divisions within the organization, including Enterprise and Divisional Leadership Teams
- Manage external partnerships with vendors, auditors, regulators, and health care providers, including effective negotiation of contracts and/or rates
- Develop and maintain strong business relationships with internal partners through business expertise and exceptional support; act as a strategic advisor
- Meet continuing education standards required for job function, thought leadership and maintenance of actuarial credentials
Is this a good fit? (Requirements):
- Bachelors Degree in Actuarial Science, Mathematics, Statistics, Economics or related field
- Fellow of the Society of Actuaries and minimum of 5 years of relevant actuarial experience or, Associate of the Society of Actuaries and minimum of 10 years of relevant actuarial experience
- Member of the American Academy of Actuaries
- 3 or more years of experience with either reserving, CMS risk adjustment projections, or Value-base Provider Payment projections
- Actuary experience
- People leadership
- Healthcare or health insurance