Fallon Health

  • Senior Director, Commercial Lead Actuary - Growing Health Plan!

    Location US-MA-Worcester
    Posted Date 4 weeks ago(3/26/2018 4:28 PM)
    Job ID
    5164
    # Positions
    1
    Category
    Finance
  • Overview

    About Fallon Health:
    Founded in 1977, Fallon Health is a leading health care services organization that supports the diverse and changing needs of those we serve. In addition to offering innovative health insurance solutions and a variety of Medicaid and Medicare products, we excel in creating unique health care programs and services that provide coordinated, integrated care for seniors and individuals with complex health needs. Fallon has consistently ranked among the nation’s top health plans, and is accredited by the National Committee for Quality Assurance for its HMO, Medicare Advantage and Medicaid products. For more information, visit www.fallonhealth.org.

    This is a great new opportunity at Fallon Health to work directly for our Chief Financial Officer and make your leadership mark overseeing all actuarial facets of our Commercial Health Insurance business.    

    The role is responsible for developing Best Practices for our Commercial lines of business and leading leading our commercial pricing, commercial rate filings, and oversee the reserving process and our gross margin forecasting models to assist the organization in developing and aligning our strategic plans with our financial outlook.In addition this key position will leverage strong communication and partnerships with the Actuarial, UW, Medical Economics, Finance, Sales, Clinical and Product teams to understand and model the most relevant factors, and highlight risks and opportunities that exist.

    For all commercial programs you will conduct actuarial studies, trend studies, develop and recommend actions to executives and to the leadership team at Fallon Health and assist in the implementation to improve plan performance – profitability and membership growth. You will all provide support to regulatory filing, management decisions, oversee the IBNR process, work with our Auditors, and complete our quarterly forecasting and business planning cycles.

    We'll be looking for string expertise in defining standards of expertise and assisting in training the actuarial staff in the use of Best Practice models while also providing strong leadership, coaching and development of the team.

    Responsibilities

     

    Develop Best Practice IBNR process

    • Review IBNR accruals monthly by line of business
    • Enhance the IBNR process
    • Review favorable/unfavorable results at monthly close meetings
    • Support financial audits related to the IBNR estimates

    Develop Best Practice actuarial gross margin forecasting models

    • Medical and pharmacy trend analysis
    • Revenue projections
    • Review of membership assumption
    • Review and vet Cost of Care assumptions
    • Understand and model benefit changes and membership mix changes
    • Understand key drivers
    • Assess risks and opportunities

    Support commercial pricing work including

    • Stay informed of federal and state based legislative change
    • Prepare and review with leadership the Merged Market and Large Group pricing reviews
    • Complete and support all regulatory rate filings
    • Work to minimize risk and obtain our business results through these changes

    Conduct actuarial studies, develop, recommend actions to senior leadership and assist in the implementation to improve commercial plan performance

    • Review actuarial assumptions, pricing methodologies and assist leadership in strategic and tactile decision making.
    • Work on negotiations and lobbying for important business/product changes.
    • Work with product line Directors on monitoring and improving business line results
    • Review actuarial assumptions, pricing methodologies and assist leadership in strategic and tactile decision making.

    Analyze competitive information from other departments within FCHP in order to keep apprised of local and industry trends

    • Assist and analyze competitive data to drive our business objectives
    • Stay informed of national and local trends regarding product and provider changes

    Qualifications

    • B.A./B.S. degree, preferably in Mathematics, Finance, Economics, or related field
    • Accreditation of ASA, FSA, or MAAA preferred
    • 10 years of successful past experience in relevant health plan/health insurance finance, medical economics, actuarial or underwriting experience
    • At least 5 years of successful past experience in relevant health plan/health insurance finance, medical economics, actuarial or underwriting experience

     

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