Highmark Health Chief Actuary - Gateway Health Plan in Pittsburgh, Pennsylvania

Description

GENERAL OVERVIEW:

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

ESSENTIAL RESPONSIBILITIES:

  1. 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.

  1. 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

  2. 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

  1. Accountable for overseeing regulatory filings

  2. Oversees the actuarial function for the Medicare bid process

  3. 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

  4. Other duties as assigned or requested.

QUALIFICATIONS:

Minimum

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

WORK ENVIRONMENT

Is Travel Required?

Yes

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.

REQNUMBER: J125342

Equal Opportunity Employer Minorities/Women/Protected Veterans/Disabled