EmblemHealth · 9 hours ago
AVP, Actuary-Government Business
New York, NY
Full-time
Hybrid
Senior Level, Lead/Staff
$162K/yr - $302K/yr
12+ years expEmblemHealth is seeking an AVP, Actuary-Government Business to oversee the development of pricing models and lead the Enterprise Government Actuarial Areas. The role involves managing Medicare and State-Sponsored Program lines of business, ensuring accurate pricing and compliance with regulatory requirements.
InsuranceNon ProfitWellness
Responsibilities
Oversee development of pricing models and their use in product strategy for Medicare and State-Sponsored Program (SSP) lines of business
Lead Enterprise Government Actuarial Areas, which includes 400,000-500,000 lives, representing over $2.5 billion in revenue
Key influencer and driver of Medicare and SSP strategy
Responsible for Enterprise Medicare bid filings, Employer Group medical pricing, Medicare Supplement Pricing, SSP Premium analytics, budgeting, reporting, and financial performance tracking
Support risk adjustment team, including forecasting revenue, monitoring and valuing activities, and reporting
Support and influence multi-year strategy development for Government business
Responsible for development and accuracy of Medicare pricing/budget assumptions in support of strategy, including new and existing Medicare plans
Support management of segment action plans to achieve margin targets
Responsible for the oversight of the filing of Medicare Advantage bids
Oversee development and filing of premium rates for all products with the appropriate regulatory authority (e.g., CMS, New York Department of Health)
Manage and develop a high-performing Actuarial team
Monitor progress on individual goals, provide support on individual development plans, and proactively plan for growth and succession
Manage analysis of underlying business performance for Government business lines
Fulfill SSP filing requirements defined by regulatory entities such as SCMS and DOH
Collaborate with segment leadership, Finance, HCE, and other teams to develop accurate forecasts
Design & develop standard reports to meet the needs of government programs and other leaders
Key point of contact for enterprise government plan analytics
Anticipate and identify key source information to analyze problems clearly, identify root causes, trends and opportunities, determine creative solutions
Provide Support to Medicare Product and Account Management areas through analyzing and improving financial performance, including risk adjustment coding accuracy to achieve targeted profitability
Qualification
Required
Bachelor's degree in Actuarial Science, Mathematics, Economics, or similar major
15+ years of actuarial experience with ASA; or 12+ years' experience with FSA
10+ years health insurance actuarial experience, preferably in Medicare
Ability to analyze complex health insurance issues such as risk modeling, impact of provider contracting changes, etc
Strong understanding of actuarial principles & methodologies related to Medicare Advantage pricing and product design
Understanding of government benefits and design
Proven track record of successfully overseeing multiple large (company/divisional) projects
Strong organizational skills and ability to prioritize and successfully manage multiple priorities/deadlines
Strong management and leadership skills – ability to develop and motivate staff
Excellent written and verbal communicator – need to be able to summarize complex analyses succinctly and be able to present results to senior management and others effectively
Executive presence; comfortable speaking with all organizational levels, within and external to, the company
Proficient with MS Office (Word, Excel, Access, PowerPoint, Outlook)
Preferred
Fellow of the Society of Actuaries strongly preferred
Company
EmblemHealth
EmblemHealth is an insurance and wellness company that offers health benefits to consumers, employers, and government purchasers.
1001-5000 employees
H1B Sponsorship
EmblemHealth has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2024 (2)
2023 (2)
2021 (2)
2020 (4)
Funding
Current Stage
Late StageLeadership Team
M
Michael Collins
Vice President CRM Applications
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