Director of Actuarial Services, Health Plan Services

Cook County, IL - Chicago, IL

Full-time - Senior

Chicago, IL

Executive, Legislative, and Other General Government Support

About the position

The Director Actuarial Services, Health Plan Services will lead, manage, and coordinate the analytical efforts supporting the rate setting process for CountyCare and Medicare programs to ensure rates are competitive, adequate, and actuarially sound. Serves as a subject matter expert and trusted advisor for health plan leadership. The Director will be responsible performing duties that include, but not limited to, competitive analysis, network analysis, risk adjustment, analyzing trends, actuarial benefit value analysis, etc. and determining the implications on premiums, risk adjustment, and strategic initiatives.

Responsibilities

• Serves as a subject matter expert overseeing all aspects of the rate setting process.
• Collects and analyzes claim and membership data to estimate potential liabilities.
• Leads and manages the risk adjustment processes and operations.
• Develops and projects actuarial models.
• Assists in the development of financial forecasts and projections including the identification of risks and opportunities.
• Provides insight and support for the reinsurance placement process.
• Recognizes and prepares opportunities to enhance analyses and improve efficiencies.
• Develops reserves and submits the documents for the incurred but not reported (IBNR) reporting.
• Reviews and analyzes regulations and potential impacts on the health plan.
• Prepares and submits all required state and regulatory report filings.
• Supports medical economics and network pricing analysis by participating in contract negotiations focusing on strategic the rate setting process that will be implemented with Medicaid.
• Assists in the development of the Medicare bid.
• Performs all functions according to established policies, procedures, regulatory and accreditation requirements, as well as applicable professional standards.
• Attends and participates in meetings, group discussions, and committees as required.
• Performs other duties as assigned.

Requirements

• Bachelor's degree in Actuarial Science, Economics, Mathematics, Applied Statistics or related field from an accredited college or university is required.
• Credential in one of the following: Associate of Society of Actuaries (ASA) or Fellows of the Society of Actuaries (FSA) designation or Chartered Enterprise Risk Analyst (CERA) is required.
• Four (4) years of actuarial experience is required.
• Three (3) years of supervising and/or managing staff is required.
• Prior actuarial experience in health care developing program rates and pricing methodologies for Medicaid and Medicare is required.
• Advanced proficiency in Microsoft Office Excel is required.

Nice-to-haves

• Master's degree from an accredited college or university is preferred.
• Prior experience in a leadership role within a Medicaid and Medicare health plan is preferred.
• Proficiency with SAS and/or SQL is preferred.

Benefits

• Medical, Dental, and Vision Coverage
• Basic Term Life Insurance
• Pension Plan
• Deferred Compensation Program
• Paid Holidays, Vacation, and Sick Time
• 100% Tuition Reimbursement for nursing-related programs