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Chief Actuary & VP Underwriting Services
Chief Actuary & VP Underwriting Services
The Chief Actuary & Vice President Underwriting Services will report directly to the Health Alliance Plan (HAP) CFO and is responsible for leading medical economics, pricing, underwriting, rate filing, reserving, forecasting and trend analysis for all lines of business of a multi-billion-dollar regional integrated health plan. The VP will partner with other executives to establish corporate goals and plans and serves as a key adviser to enterprise leaders across Henry Ford Health System (HFH) and influences pricing, reserving philosophies, strategies, and policy development. The VP also has responsibility for financial bid-related activities for HAP's Medicare Advantage programs and all of the functions of the Underwriting Department. Collaboration with the Chief Marketing Officer and others within the Sales and marketing areas in the development of strategies to meet membership and revenue targets through effective products, pricing and market segmentation. Open to hybrid/remote.
Principal Duties and Responsibilities:
• The Chief Actuary is responsible for all pricing and premium rate development and rate filing for HAP (and affiliated companies) for products and services including but not limited to
1. Insured Group Products
2. Individual Products
3. Medicare Advantage and Medicare Cost bid development
5. Self-Funded Products & Services
• Develops the actuarial strategy for the development of new products/services offered by HAP and affiliated companies.
• Oversees all commercial pricing activities, collaborates with HAP leadership and sales to implement pricing decisions and support strategic growth and financial goals.
• Leads the Actuarial team for predictive modeling for pricing development and metrics, trend analysis, benchmarking analytics and policy reserve calculations that serve as the foundation for medial cost reporting and projections.
• Oversee all medical economics reporting and analytics for the plan to understand the larger medial cost picture and provide timely insight into claim cost drivers for the business segment leaders and identification of opportunities to manage utilization and unit cost of medical services. This includes, but is not limited to:
• Provides strategic input for developing the annual medical expense budgets and routine variance reports to track performance and continuously improve analytic techniques and predictive models to support medical cost reduction.
• Develops assumptions, monitors report utilization, cost trends and partners with stakeholders to influence utilization and trends.
• Supports the development of modeling and analysis for provider networks, contracts, planning and forecasting.
• Ensures the appropriate strategy is in place for compiling and analyzing data for physicians and hospital as well as facility rates and other professional fee schedules including participating PCPs and specialists, and non-participating physicians to identify cost savings opportunities and provides meaningful reporting for providers and provider groups on cost, quality, utilization and risk score performance.
• Oversee all underwriting activities to ensure the development of appropriate premium rates. Responsible for developing and implementing underwriting guidelines and practices to meet key corporate objectives:
• For all commercial lines of business, including individual and large & small group.
• Achieve and maintain desired level of profitability.
• Top line HAP revenue and membership growth.
• Ensuring pricing is competitive.
• Coordinate with product development area on all plan designs.
• Compliance with regulatory requirements.
• Direct Finance-related activities associated with HAP’s Medicare Advantage programs in collaboration with VP, Medicare and Individual Sales. This includes, but is not limited to:
• Coordinate and manage all Finance activities related to new Medicare Product Applications, Service Area Expansions and the annual Bid process.
• Develop metrics to assure successful financial outcomes.
• Direct research and implementation for impending CMS regulations regarding risk adjustment portion of premium payments for Senior Plus and future Medicare Risk products.
• Direct interaction with CMS representatives relating to CMS inquiries or audits on risk portion of premiums.
• Provide strategic direction to premium rate discussions with employer groups and brokers and when necessary, direct interaction with key customers.
• Develop market and environmental assessments for use in the annual premium rate determination process. Work with CFO, COO and Chief Marketing Officer to develop and present to different internal constituencies (e.g., CEO, HAP Finance Committee, others) recommendations related to premium rates.
• Direct and monitor Employer Group Reporting resources. Working in close collaboration with Sales and IT, develop meaningful employer group reporting capabilities across all products. Provide strategic direction to discussions with employer groups and brokers around employer group performance including direct interaction with key customers.
• Strategy Development - In collaboration with Product Development, Lead or co-lead HAP in formulating and implementing business development strategies as directed by senior leadership.
• Strategy Execution - Work with Sales and Product Development areas to execute business development strategies including direct interaction with key employer groups and brokers.
• Develop and maintain external relationships with employer groups and other organizations for the purpose of member retention and growth.
• Perform other related duties as assigned.
• Bachelor's degree in finance, mathematics, actuarial science or other quantitative discipline.
• Master’s degree is preferred.
• Minimum of seven (7) years of health actuarial experience, including product development and new business pricing (either individual health and life, supplemental health, Medicare Supplement, and/or worksite supplemental products); strong valuation and financial reporting acumen.
• Demonstrated track record of analytical and strategic experience in advanced risk analysis and strong model development skills.
• Experience managing organizations ideally of at least five (5) direct/indirect reports as well as a proven track record of building teams and developing/mentoring employees.
Fellow of the Society of Actuaries (FSA) and Member of the American Academy of Actuaries (MAAA) designations required to serve as Appointed Actuary. Candidates with ASA Credentials will be considered, however will not be able to serve as Appointed Actuary.
Skills and Abilities:
• Strong analytic, organizational and project management skills.
• Ability to analyze the business and demographic environment to project emerging health care trends and opportunities.
• Ability to analyze internal management information and develop recommendations.
• Excellent presentation skills.
• Self-motivated and self-directed.
• Must be able to work with individuals of diverse backgrounds & skill sets at a variety of organizational levels.
• Demonstrated ability to look for alternative ways to achieve results.
• Strong interpersonal and management skills and the ability to motivate others to complete assignments.
• Ability to work with automated information systems.
• Understanding of the Affordable Care Act and requirements.
• Knowledge of diverse health benefit funding programs including fully insured and various self-funding arrangements.
• Knowledge of Medicare Advantage program, processes and regulations.
• Understanding of health care strategy, delivery, policy and financing issues.
HFHS and HAP Team Member Standards of Excellence:
Must meet or exceed core customer service responsibilities, standards and behaviors as summarized below:
• Display a positive attitude
• Take ownership and be accountable
• Offer open and constructive communication
• Respond in a timely manner
• Take pride in the system
• Respect and be sensitive to privacy/confidentiality
• Commit to team members
• Honor and respect diversity
• Maintain a clean and safe workplace environment
Time: Full time
Updated: 2/21/2023 2:17:46 PM