The Director, Actuarial Risk and Compliance is responsible for the overall management and oversight of actuaries and/or support staff where activities are concerned with identifying and managing risks. Identifies and analyzes potential risks and estimates the potential financial consequences, develops and recommends controls and cost-effective approaches to minimize risks. The Director, Risk and Compliance requires an in-depth understanding of how organization capabilities interrelate across the function or segment.
In this role you will lead a team of actuarial associates in the assessment of risk, opportunities, and mitigating strategies to assure the compliant submission of bids to support Humana's pricing and product development of Medicare Advantage and Prescription Drug Plans that positively impact the financial performance of Humana.
Supporting Humana's MA-PD and PDP bid filings by ensuring appropriate interpretation and implementation of CMS guidance, and implementation and execution of review standards and controls to minimize compliance risk associated with the bid filing.
Provide regulatory guidance and training on new, updated, and existing regulations and laws related to Medicare Advantage.
Provide strategic consulting to partners within and outside of Senior Products Actuarial
Facilitate CMS audits and reviews related to Humana's Medicare bids, including remediation of CMS Bid Audit Findings
Coordinate internal and external audits, and drive audit issues to closure
Create and maintain process improvements to bid filings to continually improve Humana's ability to file compliant bids.
Create and support cooperative working relationships, both within the company-at-large and with outside business partners
Bachelor's degree, ASA or FSA , MAAA Applies knowledge of more than three functions and more than one Segment
Typically requires Master's Degree or equivalent, 10+ years of technical experience, or equivalent, 2-5 years of project/ leadership experience
Scheduled Weekly Hours