Lead Actuary/Actuary- Senior Products-Part D

Profile

Description

The Actuary, Pricing is responsible for setting pricing assumptions, submitting bids, filing and gaining approval of premium rates and rate certifications with regulatory agencies. Supports implementation of rates, new plans and benefit changes. Provides guidance to Product Development on new product/benefit cost impacts. Develops and maintains pricing tools that price standard and custom benefits. The Actuary, Pricing works on problems of diverse scope and complexity ranging from moderate to substantial.

Responsibilities

The Actuary, Pricing establishes market level financial metrics to align with segment profitability goals, analyzes market level results and projections and develops recommended pricing actions to address gaps to targeted metrics. Leverages market level projections and experience data tools to research root cause and capture insights. Researches and understands competitors in marketplace and collaborates with sales and other partners supporting the markets to develop strategies for profitable membership growth. Accountable for actuarial certifications on rate filings, including attesting to compliance with state and federal rating and benefit regulations. Advises executives to develop functional strategies (often segment specific) on matters of significance. Exercises independent judgment and decision making on complex issues regarding job duties and related tasks, and works under minimal supervision, Uses independent judgment requiring analysis of variable factors and determining the best course of action.

This role will lead a small team with two primary roles: Driving Part D Market Strategy and Enhancing the PD Projection Accuracy.

In addition, the Lead Actuary must ensure the team:


Coordinates Market-based Assumptions for bid development

Conduct analyses to determine optimal Part D Benefit Designs for MAPD plans

Provides Part D Provider Capitation Impact Valuation estimates and guidance

Evaluates the Part D Model accuracy and provides feedback to continuously improve the PD model

Compares Part D Projections to Emerging Experience to understand variance from expectation


Required Qualifications


Bachelor's Degree

FSA or ASA plus relevant advanced degree, recent and relevant work experience, and/or other relevant professional designations.

MAAA

Strong communication skills

Experience in more than two functions (e.g., modeling, pricing, rate filing, reporting & analysis, reserving or trending)

Experience explaining and presenting complex topics to various levels of leadership, including senior level leaders


Preferred Qualifications


Experience leading a small team of actuaries (2-3 credentialed actuaries)

Several years of Medicare pricing experience

Strong technical expertise, specifically in Excel, SAS, VBA


Additional Information


Location: Louisville, KY


Scheduled Weekly Hours

40

About Us

Mission: At Humana, our cultural foundation is aligned to helping members achieve their best health by delivering personalized, simplified, whole-person healthcare experiences. Recognizing healthcare needs continue to evolve for each person, for each family and for each community, Humana continuously creates innovative solutions and resources that help people live their healthiest lives on their terms –when and where they need it. Our employees are at the heart of making this happen and that’s why we are dedicated to building an organization of dynamic talent whose experience and passion center on putting the customer first.

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