Director, Actuarial Services

Bachelor’s degree in Finance, Economics, Actuarial Sciences, Statistics, Math or another quantitative field 8+ years in healthcare with health plans, provider groups or consulting firms 5+ years doing healthcare actuarial analyses; experience in value-based care Fellow of the Society of Actuaries (FSA) or Associate of the Society of Actuaries (ASA) designation Strong ability to perform data analysis using large healthcare claims and utilization datasets Skilled in Advanced Excel modeling, with experience in SAS and SQL; familiar with R and Python Experience with Word, PowerPoint, and Excel Knowledge of standard methods for measuring health care utilization, spending, quality, and outcomes Demonstrated ability to independently lead and execute complex, high-visibility projects Proven track record of creating, maintaining, and enhancing relationships and communicating effectively with senior management Intense attention to detail and extraordinary commitment to assurance of data quality and integrity Experience with MA mechanisms and industry structure Experience functioning in a highly matrixed organization Experience developing and applying consistent analytical frameworks to contracts in the value-based care space Experience as an independent contributor in a fast-changing operational environment Passionate about driving the shift from fee-for-service to value-based care Experience working with projections of premiums, costs, MLR, and other aspects of MA forecasting

Lead actuarial modeling and financial forecasting across CMS programs Oversee the design and evaluation of value-based care payment models Direct enterprise-wide risk adjustment strategy Support contract negotiation including new contracts and renewals Partner with clinical, quality, and coding teams for risk adjustment operations Develop actuarial analyses supporting network design and provider performance Manage actuarial analysis for settlements and reconciliations Develop and maintain an actuarial/economic framework for evaluating risk Identify risks and develop mitigation recommendations Partner with data science and population health teams to enhance predictive models Interface cross-functionally and perform analyses for other MHN teams Communicate complex actuarial findings to non-technical stakeholders