Director Actuary

JOB SUMMARY:

The Director Actuary will coordinate work with CCOK’s external actuaries, work closely with Marketing, Finance, Underwriting and other departments to find solutions to assist the company in achieving long-term profitable growth. The Director Actuary will have deep Health Insurance experience and a particular focus in Medicare Advantage, to direct the calculation of risk, analysis of trends, and pricing for products and services provided by the health plan.

KEY RESPONSIBILITIES:

• Works with leadership to develop an internal actuarial function for CCOK.
• Coordinates with Underwriting/Product team and external actuaries on Medicare Advantage and ACA rate filings
• Performs analysis and maintenance of Large Group pricing models
• Leads team responsible for Medicare Advantage and ACA Risk Adjustment
• Provides custom pricing review and support for prospective and existing Large Group customers
• Provides analyses to support network design, provider contracts and area factors.
• Provides trend analysis such as cost of care, medical loss ratio, and ACA plan profitability and enrollment
• Supports Medical Management and Pharmacy teams on ad hoc projects
• Monitors market dynamics and develop competitive analysis reports
• Provides oversight and support to IBNR, PDR, and other actuarial accrual development
• Other miscellaneous analytical analysis as needed.
• Performs other job-related duties as required.

QUALIFICATIONS:

• Extremely proficient in Microsoft products: Excel, Access and Word.
• Proficient in SAS and/or other SQL based tools.
• Knowledge of health insurance underwriting principles.
• Hands on experience with the Medicare Advantage pricing and bid process.
• Experience with Medicare Advantage and ACA related Risk Adjustment and RADV reporting and analysis.
• Strong written and verbal communication skills.
• Ability to clearly explain complex statistics and technical details to a non-technical audience.
• Ability to thrive in a dynamic and fluid environment.
• Work independently to meet external and internal deadlines.
• Successful completion of Healthcare Sanctions background

EDUCATION/EXPERIENCE:

• B.S. Mathematics, Statistics, Actuarial Science or related degree.
• Associate of the Society of Actuaries (ASA) required, Fellow (FSA) preferred.
• 8 years’ actuarial experience in health insurance.