Job Title: Senior Manager Actuary - Medicare Advantage
Location: Flexible (Remote or Hybrid)
About: This company is a global leader in management consulting, with a dedicated focus on helping clients solve their toughest problems and seize opportunities. With a commitment to delivering transformative solutions, we operate across various industries, including healthcare, finance, and technology. Our team of experts combines deep industry knowledge with analytical rigor and innovative thinking to drive lasting impact for our clients.
Role Overview: As a Senior Manager Actuary within our Medicare Advantage Team, you will play a critical role in advising our clients within the healthcare sector, specifically focusing on Medicare Advantage plans. Leveraging your expertise in actuarial science and healthcare, you will lead and execute strategic initiatives, provide insights, and develop innovative solutions to address complex challenges faced by our clients.
Key Responsibilities:
Medicare Bids and Pricing: Lead the development of Medicare Advantage bids, including pricing strategies, rate filings, and bid submissions. Conduct thorough actuarial analysis to determine appropriate premium rates, cost projections, and risk adjustment factors, ensuring alignment with regulatory requirements and client objectives.
Actuarial Modeling and Analysis: Utilize advanced actuarial modeling techniques to assess plan performance, evaluate financial risks, and project future outcomes. Conduct scenario analyses and sensitivity testing to inform decision-making and optimize pricing structures. Provide insights and recommendations to enhance plan profitability and competitiveness.
Risk Management: Develop and implement risk management strategies to mitigate financial risks associated with Medicare Advantage plans. Evaluate risk corridors, reinsurance arrangements, and alternative risk-sharing mechanisms to optimize risk-adjusted returns and ensure compliance with regulatory standards.
Client Advisory: Serve as a trusted advisor to clients, providing expert guidance on actuarial matters related to Medicare Advantage pricing, bidding, and financial management. Communicate complex actuarial concepts in a clear and concise manner, fostering client understanding and confidence in decision-making.
Team Leadership: Lead a team of actuarial professionals, providing direction, coaching, and support to ensure high-quality deliverables and client satisfaction. Foster a collaborative and inclusive team culture, promoting knowledge sharing, skill development, and continuous improvement.
Regulatory Compliance: Stay abreast of regulatory changes and updates impacting Medicare Advantage plans, including CMS guidelines, risk adjustment methodologies, and bid submission requirements. Ensure compliance with regulatory standards and assist clients in navigating regulatory complexities.
Thought Leadership: Contribute to thought leadership initiatives within the actuarial and healthcare domains, including white papers, articles, and presentations. Share insights and best practices with clients and industry stakeholders to drive innovation and influence industry trends.
Qualifications:
- Bachelor's degree in Actuarial Science, Mathematics, Statistics, or a related field
- ASA required, FSA preferred
- Minimum of 7 years of experience in actuarial consulting, with a focus on Medicare Advantage plans and bid pricing.
- Proficiency in actuarial modeling software (e.g., AXIS, Prophet) and statistical analysis tools (e.g., SAS, R).
- Deep understanding of Medicare regulations, reimbursement methodologies, and risk adjustment mechanisms.
- Proven leadership experience, including the ability to lead and develop high-performing teams.
- Excellent analytical, problem-solving, and communication skills, with the ability to convey complex concepts effectively.
- Commitment to upholding professional integrity, ethics, and confidentiality in all interactions.
