VNS Health Manhattan , NY 10010
Posted 3 weeks ago
Overview
Leads the actuarial aspects of Medicare Advantage bid process, ensuring accuracy, compliance and strategic alignment with organizational goals.
Compensation:
$137,800.00 - $183,800.00 Annual
What We Provide
Referral bonus opportunities
Generous paid time off (PTO), starting at 30 days of paid time off and 9 company holidays
Health insurance plan for you and your loved ones, Medical, Dental, Vision, Life and Disability
Employer-matched retirement saving funds
Personal and financial wellness programs
Pre-tax flexible spending accounts (FSAs) for healthcare and dependent care
Generous tuition reimbursement for qualifying degrees
Opportunities for professional growth and career advancement
Internal mobility, generous tuition reimbursement, CEU credits, and advancement opportunities
What You Will Do
Leads the development and execution of the actuarial aspects of Medicare Advantage (MA) bids, including actuarial assumptions, modeling and forecasting.
Collaborates with cross-functional teams to develop bid packages that align with business objectives and regulatory guidelines. Ensures accurate and compliant submissions and facilitate successful bid approvals.
Communicates actuarial findings, assumptions, and recommendations to internal and external MA stakeholders.
Analyzes and validates data relevant to bid submissions. Reconcile bid data with reported financials to ensure data integrity and accuracy.
Establishes actuarial frameworks and optimize processes to efficiently interpret MA data, enabling timely and accurate decision-making.
Provides data and analytical support to Risk Adjustment team, Care Management and other related teams to optimize revenue and manage medical expenses.
Tracks financial performance of MA products and monitor emerging experience and trends.
Collaborates closely with reserving actuaries to develop IBNR reserves for MA products.
Provides guidance and assistance to Accounting department in establishing accruals related to MA.
Collaborates with internal and external partners to identify MA growth opportunities.
Identifies business needs and requirement for MA vendor partnerships. Track and evaluate vendor performance and alignment with growth goals.
Conducts long term projection and ROI analysis for launching new products, expanding into new markets and optimizing existing portfolio.
Serves as a subject matter expert on actuarial matters related to MA, offering mentorship and training to junior actuarial staff.
Performs all duties inherent in a supervisory role. Ensures effective staff training, interviews candidates for
employment, evaluates staff performance, and recommends hiring, promotions, salary actions, and
terminations as appropriate.
Participates in special projects and performs other duties as assigned.
Qualifications
Licenses and Certifications:
Associate of the Society of Actuaries (ASA) designation preferred
Member of the American Academy of Actuaries (MAAA) preferred
Education:
Work Experience:
Minimum five years of progressively responsible actuarial experience in a Health Plan/ Managed Care organization or similar environment required
Minimum two years experience specially related to Medicare Advantage bidding required
Knowledge of core health actuarial processes including Pricing, Valuation, and Budgeting/Forecasting preferred
Efficiency in manipulating and analyzing large and complex data sets from multiple sources using SAS. Proficient in MS Excel spreadsheets and Visual Basic. Knowledge of Pytho preferred
Ability to multi-task required
Prior experience communicate quantitative analyses and results in a clear, precise and actionable manner preferred
VNS Health