Director, Medical Expense Analysis and Rating

Purpose: We are pleased to accept resumes for consideration for either a Manager or Director level and will access qualifications upon receipt and interviews. This position will perform high level Actuarial analyses for Commercial and Medicare business and manage staff responsible for the following; including, but not limited to: medical expense analyses and projections, Small Group rating, Large Group book of business rating, financial forecasts, regulatory rate filings, and ad hoc actuarial analyses and advice. 

 

KEY ACCOUNTABILITIES:

 

1.  Hires, develops, manages and motivates a performance-based actuarial services team providing ongoing direction, leadership, evaluation, training and development of staff to maximize return and drive results.

2.  Establish and maintain actuarially sound process to analyze historical, and project future, medical expenses and required revenue.

3.  Develop and maintain actuarially sound rate normalization and renewal rating system to determine most equitable allocation of premiums to customers.

4.  Work with Sales, Underwriting, Chief Actuary, and CFO to determine premium allocation to customers resulting in optimal membership and profit levels.

5.  Develop and prepare rate filings for submission to the Department of Insurance for prior approval for large and small group commercial markets.

6.  Apply actuarial expertise to refine community rating techniques to improve CCI’s competitive position relative to price.

7.  Identify medical expense problem areas, and work with Medical Management and Network Operations to determine and implement solutions.

8.  Coordinate with Sales the determination of appropriate product pricing, prediction of product value and salability vis-à-vis competitor products, prediction of product mix and cost implications, as well as the establishing and monitoring of price relativity among and between product options.

9.  Develop/model “what if” analysis that will predict financial outcomes of various business decisions. Participate as required with Chief Actuary and other areas (CFO and Controller) in the financial management of CCI.

10.  Closely monitor and assess competitors small group rates, trends and rating methodology key to developing recommendations for rates invaluable to CCI success in this market segment.

11.  Assess the financial or pricing impact of variations in benefits and provider contracts.

12.  Estimate mandated benefit cost and calculate pricing of non-standard benefits and requested riders.

13.  Perform other related projects and duties as assigned.

 

 

TECHNICAL KNOWLEDGE, EXPERIENCE AND SKILL REQUIREMENTS:

 

1.  Bachelor's Degree required, preferably in Actuarial Science/Mathematics/Finance/Healthcare Management or a related field or an equivalent combination of education and experience.

2.  Associate or Fellow in Society of Actuaries desired.

3.  At least 5 years of previous experience in actuarial analysis required with ASA or FSA; 7 years without ASA or FSA.  Includes at least 3 years of managed care rate development.

4.  Excellent quantitative, problem solving and analytical skills.

5.  Strong communication and negotiation skills.

6.  Proficient with personal computers, spreadsheet skills in particular.

7.  Experienced in query and report development using relational database principles.

 

COMPETENCIES:

 

1.  Leadership:  Creates company image with business leaders and promotes the internal culture.

Promotes, hires, and retains a talented and diverse workforce.  Sets clear and obtainable objectives for employees.  Delivers timely and specific feedback (both positive and negative) and is effective in delivering appropriate rewards and recognition.  Sets high standards for self and others and demonstrates enthusiasm for the mission of the team.

2.  Member and Customer Focus:  Recognizes that members and customers (internal & external) are the driving force behind every business activity.  Continuously makes an effort to exceed the expectations of members and customers.

3.  Quality Orientation:  Assumes responsibility for providing the highest level of quality to members and customers.

4.  Innovation: The ability to see opportunities for change, to capitalize on them and implement them when appropriate for the benefit of ConnectiCare.

5.  Communication: The ability to communicate with clarity both orally and in writing.

6.  Teamwork: Demonstrates enthusiasm for the mission of ConnectiCare and inspires the same in others.

7.  Results Orientation:  The ability to break a complex problem down into its component parts and arrive at the appropriate solution in a timely fashion.

8.  Change Mastery:  Embraces change.

9.  Learning Orientation:  Assumes responsibility for personal and professional development.

 


ConnectiCare is an equal opportunity employer. M/F/D/V