This position is responsible for overseeing all healthcare related actuarial needs. Review trend forecasting and predictive modeling tools; define underwriting policies to reduce selection; price alternative plan designs and define product strategy; identify strategies to reduce enterprise costs; review reserves in support of audits of health care liabilities; communicate ROI for medical management and other health plan initiatives to leadership; prepare and deliver client reports and presentations; analyze, develop, and/or submit Medicare Advantage and Prescription Drug plan bid pricing tools and/or plan benefit packages. Responsible for developing the organization's premium rate structure through regular and systematic analysis and forecasting of financial/statistical data which is actuarially sound, competitive in the marketplace, and provides income in accordance with organizational goals and objectives. This position is responsible for analyzing hospital and professional claims experience, trends, and evaluating costs. Directs the preparation of rate and formula filing to the State Insurance Department and participates in public hearings concerning such matters as required.
Directs, supervises, and evaluates the work of direct staff and matrixed employees
Participates into the development of the department budget to meet corporate goals and objectives. Meets annual budgetary goals. Translates organizational plans, goals, and initiatives into assumptions for annual operating and/or capital budgets. Negotiates contracts with external vendors for products and/or services and monitors/evaluates quality and/or performance.
Directs and participates in the development, implementation, and consistent application of effective organizational policies, procedures, and practices. Develops and supports internal controls to ensure that assets are safeguarded, policies and operating procedures are followed, necessary controls are effective and efficient, and compliance with current laws and regulations is achieved.
Reviews, prepares, analyzes, and presents reports and recommendations to senior leadership regarding operations, programs, services, and/or other applicable areas of interest in order to provide concise and accurate information that aids in decision-making.
Bachelor's Degree in business, finance, or healthcare administration.
Depending upon assigned area of responsibility, position may require applicable certifications and/or licensures, including but not limited to: RN; MD or DO; Drivers License; Certified Healthcare Protection Administrator (CHPA); Certified Protection Professional (CPP); Chartered Property Casualty Underwriter (CPCU); Associate in Risk Management (ARM); CPA; SPHR; Registered Health Information Administrator (RHIA); Registered Health Information Technologist (RHIT); Certified Healthcare Facility Manager (CHFM); Certified Facility Manager (CFM); Certified Coding Specialist (CCS); Certified Professional Coder (CPC); JD from an American Bar Association accredited school; admission to a State Bar Association.
Requires experience in health actuarial services typically achieved with 7-10 or more years of experience, including supervisory experience. Requires the ability to lead new business development activities, as well as annual business planning/execution and strategic planning as needed. Knowledge of health care and state government, familiarity with Medicaid, Commercial and Medicare related products. Demonstrated leadership capabilities, self-motivation, and a strong understanding of sales and relationship management. Excellent writing, communications and presentations skills are required. Strong analytical skills and ability to establish and maintain effective relationships with customers and gain their trust and respect.
Licenses/Certification: Actuarial/Associate of the Society of Actuaries (ASA) or Actuarial/Fellow of the Society of Actuaries (FSA) preferred.
Additional related education and/or experience preferred.
You want to change the health care industry – one life at a time. You belong here. You’re excited to be part of the dramatic changes happening in the health care field. In fact, you thrive on change. But you also understand that excellent, compassionate patient care is the true measure of the success of these changes. You belong at Banner Health. Our award-winning, comprehensive health system includes 23 hospitals in seven western states, primary care health centers, research centers, labs, a network of physician practices and much more. Throughout our system, skilled, compassionate professionals use the latest technology to change the way care is provided. If you’re looking to be a key contributor to a forward-looking organization, you’ll experience a wide variety of professional advantages: •Our vision for changing the future of health care gives you the opportunity to leverage your abilities to achieve something historic. •Our expansive system offers you an unmatched variety of clinical settings – from large urban trauma center to small rural hospital, ambulatory to home health. Our system also includes hospitals specializing in cancer, heart health and pediatrics. •Our many loc...ations also translate into a broad selection of exciting and rewarding lifestyle options – from the big city to the wide-open spaces. •Our commitment to healthcare innovation means you always have the latest technologies at your fingertips to help you provide the finest care possible. •The size, success and growth of our system provide you with the stability and options to pursue your desired career path. •Our competitive compensation and comprehensive benefits offer you options to complement your unique needs.