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Univera Healthcare · 1 month ago

Manager of Actuarial Services

Buffalo, NY

Full-time

Hybrid

Mid, Senior Level

$123K/yr - $222K/yr

7+ years exp

Univera Healthcare is seeking a Manager of Actuarial Services to oversee a team responsible for financial projections and actuarial analyses for complex projects. The role involves managing actuarial assumptions, preparing financial reports, and ensuring compliance with actuarial standards.

Health CareInsuranceMedicalNon Profit

Comp. & Benefits

Responsibilities

Oversees the development and maintenance of sound liability estimation methodologies. Manages recommendations for reserves for blocks of business and in total, organizes analyses to support recommendations

Leads preparation of accruals/liabilities for CMS Part D risk sharing and Part C revenue settlements

Leads preparation and submission of NYS Insurance Department quarterly and annual reports, including NAIC, NY Supplement and HMO Statements

Leads preparation and submission of Regulation 146 and Direct Pay Stop Loss reports to the NYS Insurance Department

Oversees the submission and quality of NYS and CMS regulatory encounter submissions and supports all required audits, internal and external to ensure accuracy. Leads preparation reporting, valuation, and forecasting of risk adjustment scores and revenue to support partners internal and external, including providers and vendors

Manages the development of financial plans, forecasts, and other financial projections

Prepares, or obtains externally, actuarial statements of opinion for rate and product filings and financial statements for assigned business segments

Leads preparation of Medicare Advantage bids and coordinates CMS bid review responses

Recommends regional or product line profitability targets; ensures pricing is consistent with established targets for those business segments priced in actuarial

Develops and maintains rates, rating factors and rate filings. Develops and maintains rating methods and models

Provides guidance to the Health Plan product development process

Oversees the development of competitive product and rate comparisons and analyzes competitive developments in the marketplace

Monitors developments in actuarial techniques, researches laws and regulations applicable to actuarial science and insurance operations

Provides counsel on current and proposed health plan Underwriting guidelines for commercial and Medicare eligible subgroups

Consistently demonstrates high standards of integrity by supporting the Lifetime Healthcare Companies’ mission and values, adhering to the Corporate Code of Conduct, and leading to the Lifetime Way values and beliefs

Maintains high regard for member privacy in accordance with the corporate privacy policies and procedures

Maintains knowledge of all relevant legislative and regulatory mandates and ensures that all activities are compliant with these requirements

Conducts periodic staff meetings to include timely distribution and education related to departmental and Ethics/Compliance information

Regular and reliable attendance is expected and required

Performs other functions as assigned by management

Qualification

Actuarial experienceFinancial projectionsActuarial Standards of PracticeMicrosoft OfficeSASCognosExam progressionProcess improvementsTechnical translationNon-Actuarial functionsCommunication skills

Required

Bachelor's degree in math, economics, actuarial science, or related field required

Seven (7) years of actuarial experience

Prior experience supervising or managing people and/or projects or indirectly leading teams

Advanced knowledge of financial and risk health arrangements

Strong skills including proficiency in Microsoft Office, SAS and Cognos

Strong verbal and written communication skills with the ability to present clear and concise information to all audiences

Ability to design and implement process improvements

Ability to translate technical concepts into business language

A thorough understanding of non-Actuarial functions such as Rating & Underwriting, Finance, Provider Contracting, Network Management, Product Development, Medical Management, Marketing & Sales, etc. and how they impact Health Plan operations, financials and forecasts

In depth understanding of Actuarial Standards of Practice developed and promulgated by Actuarial Standards Board

Ability to work prolonged periods sitting and/or standing at a workstation and working on a computer

Ability to travel across the Health Plan service region for meetings and/or trainings as needed