Highmark Health Chief Actuary - Gateway Health Plan in Pittsburgh, Pennsylvania
Accountable for all pricing of Gateway Health’s insurance products including Medicare, Medicaid, and LTSS for all States.
Work closely with Gateway’s senior leadership to ensure that product pricing structures support corporate strategic and financial objectives.
Accountable for ensuring that month end actuarial assumptions and development of IBNR models are accurate and appropriate
Oversee the annual Medicare bid process
Responsible for the contractual relationship for all outside actuarial support
Oversee the hiring and development of the Gateway actuarial department
Oversee the development of medical cost data to support the monthly product meetings with senior leadership
Serve as one of the lead negotiators and contacts with the States concerning rate negotiations
- Lead the Actuarial Function
Accountable for setting goals, priorities, and norms
Responsible for monitoring and managing performance
Develop staff, assess area, and ensure that appropriate resources are available
Lead the continual development of the team of risk management professionals including actuaries as well as non-actuaries
Accountable for developing budgets and managing spending
Responsible for ensuring that corporate standards and procedures are followed. Ensure that adequate internal controls are adhered to.
Responsible either directly or through subordinate staff for providing support and advice to senior management, Product Management & Development, Sales, and to other areas of Finance
Accountable for the development and oversight of IBNR
Oversee development of monthly triangles by major medical expense line
Responsible for the monthly IBNR packet reviewed with CFO and CEO as part of monthly close process
Responsible for providing support for monthly product review meetings
Responsible for selection and oversight of external appointed actuary
Accountable for interactions with all States and CMS regarding actuarial information
Leads the Actuarial support for product development
Accountable for overseeing regulatory filings
Oversees the actuarial function for the Medicare bid process
Accountable for coordinating the development and maintenance of pricing and risk management policies and the development of actuarial modeling for new State offerings and products
Other duties as assigned or requested.
Bachelor’s degree in Mathematics, Economics, Actuarial Science
Seven (10) years of healthcare pricing experience
Designation as ASA and Membership in the American Academy of Actuaries (MAAA) is required
Designation as Fellow of the Society of Actuaries (FSA) or a minimum of tent (10 years of experience in the Actuarial field (including at least seven (7) years of healthcare pricing experience) is required
Five years managerial experience at the Director level
Knowledge, Skills and Abilities
- Underwriting experience
SCOPE OF RESPONSIBILITY
Does this role supervise/manage other employees? Yes
Is Travel Required?
This job requires the ability to work as a team member. Additionally, this job requires the willingness and ability to report to work on a regular and timely basis and may require irregular work hours, holidays and/or weekends.
Equal Opportunity Employer Minorities/Women/Protected Veterans/Disabled