Director of Actuarial Services - Medicare
We are seeking a highly skilled and experienced professional to join our client's team as the Director of Actuarial Services, specializing in the Medicare space. The successful candidate will play a pivotal role in overseeing actuarial functions related to Medicare Advantage, bids, Stars, and risk adjustment. This leadership position requires a strategic thinker with a deep understanding of actuarial principles, Medicare programs, and a proven track record in driving successful outcomes in the complex healthcare landscape. Responsibilities: Medicare Advantage Oversight: Lead and manage actuarial teams responsible for the development and maintenance of Medicare Advantage pricing models. Analyze market trends, regulatory changes, and competitor strategies to ensure our Medicare Advantage offerings remain competitive and compliant. Bid Strategy and Development: Collaborate with cross-functional teams to develop comprehensive and accurate bids for Medicare Advantage programs. Ensure the accuracy of pricing assumptions, risk adjustments, and financial projections in bid submissions. Stars Rating Optimization: Implement and oversee strategies to improve and maintain high Stars ratings for Medicare Advantage plans. Collaborate with operational teams to identify and address areas for performance improvement that impact Stars ratings. Risk Adjustment Management: Develop and implement robust risk adjustment models to accurately reflect the health status of Medicare Advantage members. Collaborate with data analytics teams to identify opportunities for improvement in risk adjustment processes. Regulatory Compliance: Stay abreast of changes in Medicare regulations, guidelines, and policies to ensure compliance in all actuarial practices. Work closely with legal and compliance teams to address regulatory challenges and implement solutions. Cross-functional Collaboration: Foster strong partnerships with cross-functional teams, including finance, operations, compliance, and product development, to align actuarial strategies with overall business objectives. Talent Development: Recruit, mentor, and develop a high-performing actuarial team. Provide guidance and support for professional development to ensure the team stays at the forefront of industry best practices. Qualifications: Bachelor's degree in Actuarial Science, Mathematics, Statistics, or related field. Advanced degree or professional certification (FSA, ASA) preferred. Minimum of [X] years of experience in actuarial roles within the Medicare space, with a focus on Medicare Advantage. In-depth knowledge of actuarial principles, healthcare financing, and regulatory landscape. Strong analytical and problem-solving skills with the ability to translate complex actuarial concepts into actionable strategies. Excellent communication and leadership skills, with the ability to influence and collaborate across departments. Proven track record of successful bid submissions If you are a dynamic and strategic thinker with a passion for shaping the future of healthcare through actuarial excellence, we invite you to apply for this challenging and rewarding leadership role. Join us in making a meaningful impact on the Medicare landscape!
Negotiable
United States of America
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Actuarial Analyst
My Client, a leading HMO, is looking to add an Actuarial Analyst to join their innovative team. There is a lot of room for internal growth, exposure to new products, and an inclusive work culture. Position Overview: My client, a leading HMO, is seeking a talented and motivated Actuarial Analyst to join their actuarial team. In this role, you will focus on analyzing and interpreting data related to Commercial, ACA, and Medicaid lines of business. As an integral part of our organization, you will contribute to the development of pricing, valuation, and financial projections, ensuring the financial health of the organization while maintaining compliance with regulatory requirements. Responsibilities: Perform actuarial analysis to support pricing, rate development, and product design for Commercial, ACA, and Medicaid products. Collaborate with cross-functional teams to gather and analyze data, ensuring accuracy and completeness in actuarial models. Assist in the development and maintenance of financial forecasting models and tools for strategic decision-making. Conduct trend analysis and provide insights into key drivers impacting the financial performance of the Commercial, ACA, and Medicaid portfolios. Participate in the preparation of regulatory filings and respond to inquiries from regulatory authorities. Monitor and evaluate emerging trends in the healthcare industry, keeping abreast of changes in regulations and their potential impact. Qualifications: Bachelor's degree in Actuarial Science, Mathematics, Statistics, or a related field. 2+ exams towards ASA designation 2+ years of actuarial experience, with a focus on Commercial, ACA, or Medicaid lines of business. Proficient in actuarial modeling software and programming languages (e.g., SQL, R, Python). Strong analytical and problem-solving skills, with attention to detail.
US$110000 - US$130000 per year
United States of America
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Commercial Underwriter
One of the nation's leading stable insurance carriers is looking to add a Commercial Lines Underwriter to their growing team. They are looking for someone with a willingness to learn, and a strong understanding of commercial lines. You will be joining a tight-knit group of underwriters with an amazing culture. What you will be responsible for Underwriting across multiple commercial lines Evaluate commercial insurance applications and determine eligibility based on company guidelines Collaborate with other departments to develop and implement underwriting policies and procedures What you'll need to be successful 2+ years of underwriting experience Previous experience with commercial lines such as auto, workers compensation, etc. Excellent communication and customer service skills Evaluate the financial stability of businesses seeking coverage. Review financial statements, credit reports, and other relevant documents to gauge the financial health of the applicant.
Negotiable
Austin
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Commercial Underwriter
One of the nation's leading stable insurance carriers is looking to add a Commercial Lines Underwriter to their growing team. They are looking for someone with a willingness to learn, and a strong understanding of commercial lines. You will be joining a tight-knit group of underwriters with an amazing culture. What you will be responsible for Underwriting across multiple commercial line Evaluate commercial insurance applications and determine eligibility based on company guideline Collaborate with other departments to develop and implement underwriting policies and procedures What you'll need to be successful 2+ years of underwriting experience Previous experience with commercial lines such as auto, workers compensation, etc. Excellent communication and customer service skill Evaluate the financial stability of businesses seeking coverage Review financial statements, credit reports, and other relevant documents to gauge the financial health of the applicant.
Negotiable
Austin
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Senior Reporting Solutions Analyst
Responsibilities: Lead a reporting team through the entire lifecycle of reporting solutions, from ideation to implementation. Offer expert-level guidance to business users and report developers on enterprise reporting tools, actively seeking innovative tools to maximize their value. Serve as a lead consultant, determining and fulfilling business user reporting requirements while advocating optimal solutions based on BI best practices. Act as a subject matter expert in reporting, acquiring necessary business domain knowledge. Provide second-level support for reporting issues. Recommend BI tools and assist business users in selecting appropriate tools and reports for their objectives. Deliver training solutions for the enterprise as needed. Prepare, analyze, and document business requirements. Influence the business to test ideas and assumptions using data and analytical tools. Act as a project leader/iteration manager on small to medium-sized projects. Demonstrate a strong understanding of the BI development lifecycle for reporting and data warehouse solutions. Exhibit strong communication and soft skills to lead others in consulting and technical engagements. Conduct code peer reviews. Qualifications: Hold a Bachelor's degree in information systems or a related field, or possess equivalent education and experience. Have 7+ years of experience using MicroStrategy and/or QlikView, with a preference for candidates holding the MicroStrategy Certified Engineer designation. Demonstrate expert knowledge of relational database models (Oracle, DB2, SQL Server, Teradata, Netezza), ETL architecture, and data modeling. SSIS programming experience is a plus. Possess 5+ years of SQL programming experience. Have experience managing unstructured data in distributed ecosystems like Hadoop (preferred). Ability to work independently under general supervision. Project management experience is a plus. Competent to work at the highest technical level of all phases of application systems analysis and programming activities, with experience leading teams without authority. Must possess excellent interpersonal and communication skills, strong problem-solving abilities, and the self-motivation to improve skills. Demonstrate leadership, professionalism, and preferably an understanding of the insurance business. Be a MicroStrategy expert from an administration and architecture standpoint, not limited to report development. MSTR Certification is highly desired. Knowledge of MSTR Cloud Architecture is highly preferred. Must have strong SQL knowledge.
US$117000 - US$130000 per annum
Columbus
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Senior Med Econ Analyst
A leading Health Plan is looking for a Medical Economics Analyst to join their team. Your role is instrumental in analyzing Medicare Advantage medical claims data provided by health plan partners. You will work closely with membership files from health plans to ensure proper payments are received for the Medicare Advantage risk population. Your expertise in healthcare economics and data analysis will be pivotal in providing analytics to the organization, shedding light on Medicare Advantage population cost trends, and supporting strategic decision-making. Responsibilities Medicare Advantage Claims Data Analysis Utilize advanced statistical techniques to analyze and interpret Medicare Advantage medical claims data received from health plan partners. Identify patterns, outliers, and critical insights to inform decision-making. Work with membership files from health plans to validate and ensure accurate payments for the Medicare Advantage risk population. Provide comprehensive analytics to the organization regarding Medicare Advantage population cost trends. Prepare and present detailed reports and dashboards specific to Medicare Advantage, communicating key findings and recommendations. Qualifications: Bachelor's or Master's degree in Economics, Finance, Healthcare Management, or a related field. Experience working on Medicare Advantage Knowledge of Medicare Advantage economics, reimbursement methodologies, and healthcare policy. Excellent communication and interpersonal skills. Preferred Skills: Experience with SQL and SAS. In-depth knowledge of Medicare Advantage regulations, compliance requirements, and risk adjustment methodologies. Previous experience in a similar role within the health insurance or managed care industry, with a focus on Medicare Advantage.
Negotiable
England
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Head of Product (HNW Insurance)
As the Head of Product you will be responsible for leading and managing the overall product strategy and development for their insurance offerings. We are seeking an experienced professional who can drive innovation and growth while ensuring that our products align with customer needs and market trends. Responsibilities: Product Strategy and Vision: Develop and execute a comprehensive product strategy that aligns with the company's overall goals and market trends in the insurance industry. Create a compelling product vision that differentiates our offerings and drives growth. Product Development: Lead the end-to-end product development process, from ideation to launch, ensuring the timely and successful delivery of new insurance products and enhancements. Collaborate with cross-functional teams, including underwriting, sales, marketing, and IT, to bring products to market effectively. Market Analysis: Conduct thorough market research and analysis to identify emerging customer needs, competitive landscape, and industry trends. Utilize insights to identify opportunities for product innovation and differentiation. Product Lifecycle Management: Oversee the entire product lifecycle, including product planning, pricing, positioning, and ongoing performance evaluation. Continuously assess product performance, conduct competitive analysis, and implement product enhancements or modifications as required. Qualifications: Bachelor's degree in Business, Marketing, or a related field. Advanced degree preferred. Extensive experience (8+ years) in product management within the insurance industry, with a focus on life, health, or general insurance. In-depth knowledge of the insurance market and regulatory landscape in Hong Kong. Proven track record of successfully developing and launching insurance products in a competitive market. Strong strategic thinking and analytical skills, with the ability to translate complex data into actionable insights.
Negotiable
Hong Kong
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Actuarial Analyst
Overview: A leading consulting firm based in Chicago, is seeking a highly motivated and analytical individual to join our Commercial Team as an Actuarial Analyst. This is a remote position, allowing candidates from anywhere in the United States to apply. Responsibilities: 1. Actuarial Analysis: Conduct actuarial analysis and modeling for standard commercial projects. Collaborate with senior actuaries to support pricing, reserving, and financial forecasting.Data 2. Management: Gather, validate, and analyze data to ensure accuracy and relevance. Utilize statistical tools to interpret data and draw meaningful conclusions. 3. Collaboration: Work closely with cross-functional teams to provide actuarial support and insights. Collaborate with clients and internal stakeholders to understand business needs. 4. Documentation and Reporting: Prepare and present reports to communicate findings and recommendations. Maintain accurate documentation of methodologies, assumptions, and results. 5. Regulatory Compliance: Stay informed about industry regulations and ensure compliance in actuarial practices. Assist in responding to regulatory inquiries as needed. Qualifications: Bachelor's degree in Actuarial Science, Mathematics, Statistics, or a related field. At least 2 exams passed toward ASA designation. Strong analytical and problem-solving skills. Excellent communication and interpersonal skills. Proficient in Microsoft Excel and actuarial software (e.g., SAS, R, or Python). Ability to work independently and collaboratively within a team. Attention to detail and a commitment to producing high-quality work. Benefits: Competitive base salary based on experience and exam progression. Comprehensive health, dental, and vision insurance. Retirement savings plan with employer matching. Professional development opportunities and support for continuing education. How to Apply: Interested candidates should submit their resume or email it This company is an equal opportunity employer. We encourage candidates from diverse backgrounds to apply.
US$65000 - US$100000 per year
United States of America
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Medical Economics Analyst
We are seeking talented Medical Economics Analyst to join the team of a leading health plan. This role with be reporting directly into the VP of Medical Economics and be a part of a fast growing team! On this team, you will be responsible for helping build tools from the ground up which will allow you to make a huge impact. What you will be responsible for: Review and analyze clinical data, pharmacy data, health plan payer data, and more to develop reports critical to business needs. Build data model from scratch using SQL, however strong technical experience with Excel, Power Query, or Power BI are also welcome. Collaborate cross functionally to develop reports to measure care model outcomes and present to executive leadership. What you need to be successful: 3-5 years of experience in Medical Economics, Healthcare Analytics, or similar field. Hands on involvement working with Healthcare data, EHRs, or Value Based Care projects. Strong Background with SQL, Excel, Power Query, Power BI, or other similar software. Understanding of Actuarial practices.
Negotiable
Baltimore
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Associate Actuary
Key Responsibilities: Annuity Valuation Expertise: Leverage your 2-5 years of actuarial experience to calculate TAX, STAT, and GAAP valuations using CASE valuation software for our diverse portfolio of life and annuity products. Modeling Mastery: Utilize your modeling skills to enhance and develop actuarial models, contributing to the optimization of our valuation processes. Cross-Functional Collaboration: Collaborate with various departments, gaining exposure to different areas of the company and contributing valuable insights to strategic initiatives. Technical Proficiency: Showcase your well-rounded technical skills, including expertise in software such as SQL and Prophet, to elevate the team's capabilities. Regulatory Compliance: Ensure compliance with regulatory standards, staying abreast of industry changes, and contributing to the enhancement of our valuation processes. Qualifications: Educational Background: Bachelor's or Master's degree in Actuarial Science, Mathematics, Statistics, or a related field. Professional Designation: ASA preferred, or actively pursuing exams with a strong commitment to achieving the designation. Annuity Valuation Experience: Demonstrated proficiency in annuity valuation with 2-5 years of relevant experience. Software Skills: Experience with CASE valuation software, SQL, and Prophet. Collaborative Spirit: Strong communication and interpersonal skills, with the ability to work seamlessly within a collaborative team.
Negotiable
Texas
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