Lead Actuary

Candidates hired for remote positions must reside in Oregon, Washington, Utah, Idaho, Arizona, or Nevada.

Job Title	Lead Actuary
Exemption Status	Exempt
Department	Finance
Manager Title	Actuarial Services Manager
Direct Reports	n/a
Requisition #	23266
Pay and Benefits	Estimated hiring range $133,450 - $161,480, 7% lead pay, 5% bonus target, full benefits. To learn more about our benefits, please visit
Posting Notes	This role will focus on Utilization Management

Job Summary

This senior level position is responsible for leading and performing a wide variety of financial and actuarial analyses impacting strategic decision making and the company's financial sustainability efforts. Areas of analysis include cost and utilization trend analysis, return on investment evaluations, Medicare bid development, rate setting optimization, forecasting support, benchmarking, risk adjustment optimization, provider payment evaluation and review of actuarial estimates such as IBNR and PDR. This position provides financial stewardship by identifying opportunities for improved financial performance and working collaboratively with other departments to socialize, communicate and inform decision making.

Essential Responsibilities

Financial and Actuarial Analyses

• Drill down into cost and utilization trends to identify key drivers.
• Develop profitability analytics to support evaluation by provider group, contract, and other valued indicators.
• Lead the design, development, and implementation of evaluation tools in measuring the effectiveness of programs and payment models.
• Develop cost savings calculators for use in goal setting, budgeting, and forecasting.
• Provide rate setting support through data analysis, policy review and strategy development.
• Identify any actuarial unsound adjustments to the rates.
• Provide medical cost and utilization trend recommendations for forecasting purposes.
• Gather and develop benchmarks for purposes of assessing our performance and the potential for improvement.
• Monitor risk adjustment applied to capitation revenue and ensure population risk is appropriately represented in encounter data.
• Develop and evaluate provider payment models, including risk share arrangements, to ensure they achieve the desired outcome.
• Prepare regular risk share reporting for sharing with providers and supporting accounting estimates.
• Drive strategic use of data to support business efficiencies and competitive decision-making.
• Review and provide guidance on actuarial estimates of IBNR, PDR and other actuarially determined assets and liabilities.
• Coordinate and review the work of outside actuaries to facilitate access to plan information necessary to support their work and ensure the company's interests are represented.

Financial Analytical Capacity and Capability

• Work with Information Systems to ensure access to a data source with high data integrity.
• Work collaboratively with the Business Intelligence department and other analysts to share best practices around using the data, ensure strong data governance and maintain a community of practice resource.
• Provide training and support to other Finance users around the data, software, and analytic approaches.

Administration

• Participate in 1:1, team, and department meetings; Attend All Staff meetings.
• May participate in broader, functional discussions and initiatives across Finance Department.
• Draft, recommend, and implement plans, policies, and procedures; participate in Actuarial Services team goal setting.

Employee Leadership

• Provide leadership for a team in support of team direction and goals.
• Provide input into staffing needs; assists in recruiting and hiring staff, using an equity, diversity, and inclusion lens.
• Participate in organizing, scheduling, monitoring, and improving work; helps ensure employees have information to meet job expectations and have coverage during absences.
• Contribute to the development, communication, and oversight of team and individual goals.
• Train, lead, and coach employees; may facilitate team meetings.
• Incorporate guidance from CareOregon equity tools into people leadership.
• Help monitor employee adherence to department and organizational standards, policies, and procedures.
• Assist in evaluating employee performance, providing feedback to support success, recognizing strong performance, and addressing performance gaps and accountability (corrective action).
• Perform lead tasks in collaboration with Human Resources as needed.

Organizational Responsibilities

• Perform work in alignment with the organization's mission, vision and values.
• Support the organization's commitment to equity, diversity and inclusion by fostering a culture of open mindedness, cultural awareness, compassion and respect for all individuals.
• Strive to meet annual business goals in support of the organization's strategic goals.
• Adhere to the organization's policies, procedures and other relevant compliance needs.
• Perform other duties as needed.

Experience and/or Education

• Bachelor's Degree in Finance, Mathematics, Economics, or related field
• Associate of the Society of Actuaries
• Minimum 5 years' experience in an actuarial role
• Work experience in health insurance

Preferred

• Fellow of the Society of Actuaries
• Work experience in Medicaid or Medicare
• Experience with people and/or project leadership

Knowledge, Skills and Abilities Required

Knowledge

• Working knowledge of other MS tools, including MS Office products, MS Access
• Strong understanding of data systems and sources and how it impacts the data available
• Knowledge of medical claims, billing practices and health insurance requirements

Skills and Abilities

• Proficiency in MS Excel
• Skills and basic understanding of managerial concepts and techniques in areas such as work planning, training, delegating, coaching, mentoring, and evaluating
• Strong data management skills
• Highly effective communication skills, including listening, verbal, and written
• Willingness to acquire new skills
• Ability to identify, implement, and lead process improvements
• Strong ability in articulating and presenting information across multiple areas of the organization
• Strong ability to communicate and present to external parties (e.g., auditors, actuaries, regulatory agencies) and stakeholders (e.g., Finance committees, Board of Directors, etc.)
• Ability to collaborate effectively with department management
• Strong attention to detail and accuracy
• Ability to produce high quality output requiring minimal review
• Ability to effectively review others' work
• Ability to identify problem, inconsistencies, unexpected results, relevant information and uncertainties
• Ability to interpret and analyze information and implement conclusions/solutions
• Ability to effectively lead and participate on a variety of large projects, including complex initiatives across departments
• Ability to build team spirit and consensus
• Ability to assist team members in developing conclusions and solutions
• Ability to effectively prioritize own work and to complete tasks on time
• Ability to effectively collaborate with coworkers, leaders, executives and stakeholders
• Ability to learn from feedback and embrace change
• Possess a high degree of initiative, motivation, and professionalism
• Ability to maintain a positive attitude

• Ability to work effectively with diverse individuals and groups

• Ability to learn, focus, understand, and evaluate information and determine appropriate actions
• Ability to accept direction and feedback, as well as tolerate and manage stress
• Ability to see, read, and perform repetitive finger and wrist movement for at least 6 hours/day
• Ability to hear and speak clearly for at least 3-6 hours/day

Working Conditions

Indoor/Office Community Facilities/Security Outdoor Exposure

Member/Patient Facing: No Telephonic In Person

Hazards: May include, but not limited to, physical and ergonomic hazards.

Equipment: General office equipment and/or mobile technology

Travel: May include occasional required or optional travel outside of the workplace; the employee's personal vehicle, local transit or other means of transportation may be used.

#LI-Remote

Candidates of color are strongly encouraged to apply. CareOregon is committed to building a linguistically and culturally diverse and inclusive work environment

Veterans are strongly encouraged to apply.

Equal opportunity employer. This company considers all candidates regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, disability or veteran status.