Actuary, Risk and Compliance
New
J
JobgetherHealthcare Insurance
Based in United StatesFull-TimeSenior
SalaryBase salary range of $129,300–$177,800 per year
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Job Details
- Experience
- 8+ years of relevant technical experience
- Required Skills
- ComplianceRisk Management
Requirements
- Bachelor’s degree required.
- 8+ years of relevant technical experience.
- At least 2 years of project leadership experience.
- Associate of the Society of Actuaries (ASA) or Fellow of the Society of Actuaries (FSA) designation required.
- Member of the American Academy of Actuaries (MAAA) required.
- Strong understanding of actuarial risk assessment, regulatory requirements, insurance operations, and financial risk analysis.
- Demonstrated ability to analyze complex problems and evaluate potential financial consequences.
- Excellent written and verbal communication skills.
- Medicare Advantage experience (pricing, product development, bid submissions, or CMS requirements) is preferred.
- Experience managing large projects involving both actuarial and non-actuarial teams is preferred.
Responsibilities
- Identify, assess, and communicate actuarial and business risks, including potential financial impacts and appropriate mitigation strategies.
- Support Medicare Advantage and Prescription Drug Plan bid filings by interpreting and implementing applicable CMS guidance, review standards, and compliance controls.
- Maintain the internal version of the CMS Out-of-Pocket Cost (OOPC) Model, coordinate required inputs from business partners, and run and interpret model results.
- Partner with pricing actuaries to investigate and resolve OOPC and Total Beneficiary Cost test failures and other compliance issues.
- Develop and maintain processes and controls designed to reduce compliance risk and improve the accuracy and consistency of bid submissions.
- Participate in CMS audits, regulatory reviews, and other assessments related to Medicare bids.
- Provide actuarial peer review, technical counsel, and guidance on company, industry, regulatory, and actuarial practices.
- Advise senior leaders on significant actuarial, regulatory, and risk-related matters and contribute to functional strategies.
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