Job Description

The Chief Actuary is responsible for finding solutions to balance costs and risks, conducting regular rate, RX and administration analysis, researching and pricing products, and the financial impacts relating to product development. The Chief Actuary is responsible for developing the organization's Health Plan premium rate structures, through regular and systematic analysis, and forecasting of financial/statistical data in a manner that is actuarially sound, competitive, and that provides margin in accordance with organizational goals and objectives. In performing this role, this position oversees the rate filing processes, which includes both internal analysis and external coordination and collaboration with consultants and regulatory officials, including the Department of Insurance. The Health Plans business includes Commercial Large Group and ACA Small Group & Individual / Merged Market, Medicaid, and Medicare. This position is also responsible for leading the development of risk-sharing budgets and trends, the Large Group Underwriting Bank Account development and monitoring, and other related analytic work and financial control processes. Key customers include ELT, Sales, Network, Medical Management, and Underwriting leaders. In addition, this position will work closely with the legal department to identify, size, and communicate financial risks and opportunities related to legislative and regulatory changes, including impacts to premiums, benefits, and product designs. The candidate is required to be comfortable both within and outside of the traditional actuarial discipline to broaden his or her sphere of influence. It is crucial to be able to prioritize work for maximum impact while keeping all constituents motivated and engaged.

Essential Functions:

• Leads the development of trends and other components of rate filings across all applicable product lines. Work collaboratively with key internal stakeholders and external consultants. Lead the follow-up analysis, and research/answer all inquiries from the DOI and other regulatory agencies as necessary
• Provides financial and analytic support for the annual Medicare Bid process, the Medicare Supplement business and maintenance of EGWP rating models and pricing, and trend analytics, including:

Medicare Advantage bid development – benefit change valuation and bid form creation support in collaboration with external actuarial firm

Medicare Advantage program evaluation – examine the impact of programs designed to manage cost, product/geographic performance, and expansion opportunities

• Provides Medicaid analytical support periodically, as necessary as follows:

Annually, the Medicaid rate packet development. Examines methodologies, analyzes historical data and projects future claims expense to assist in advocacy for adequate rates from the Executive Office of Health and Human Services (EOHHS)

Medicaid clinical program evaluations. Develops methods to analyze the impact of clinical programs designed to control medical costs and resultant trend

• Leads collaborative efforts with Actuarial & Analytics Manager, Sales, and Underwriting to develop, implement and manage an annual Large Group "Bank Account" process that ensures premium rate targets are aligned with budget and achieved
• Responsible for state and federal required regulatory reporting (e.g., MA Medicare Supplement Filing, Federal MLR), and provides actuarial support for the development and monitoring of alternate provider reimbursement models
• Oversees monthly IBNR and reserves using paid claims, pended/inventory, extensive claim reports, regression, and other data, tools, and methodologies as appropriate. Complete monthly comparison of internal results to consultant models/output and reconciliation for final reserve sign-off
• Other responsibilities include reviewing monthly financial statement assets/liabilities of an actuarial nature, preparation of annual budgets by the line of business as well as monthly internal financial reporting, including performance drivers, forecasting, variance from the budget, and root-cause analytics
• Works closely with Provider Contracting, Director of Financial Services, and ELT to develop provider risk-sharing budgets and related value-based reimbursement models
• Ensures that complexity is reduced to produce high-quality work with an eye towards accuracy
• Builds an understanding of HNE’s competitors and the market in general
• Scans and monitors the legislative environment and collaborate with legal department to identify, size, and communicate emerging financial risks and opportunities related to regulatory changes, including impacts on premiums, benefits, and product designs
• Supports CFO and ELT in understanding emerging competitive landscape concerning rates and trends
• Collaborates with Underwriting and Rating, Sales and Product Development to develop and implement appropriate rating strategies for small group, large group, and individual lines of business. Ensures that all strategies are in compliance with rate filings and applicable regulations
• Manages activities associated with CHIA, DOI, CMS and other external regulatory agencies
• Provides leadership and direction to department staff; establishes annual performance objectives and evaluates performance and competency development opportunities
• Responsible for the development and implementation of a high-performance coaching culture
• Assists individuals as well as the team in development plans and goals

Minimum Requirements:

Bachelor’s degree in Business, Finance, or related field (Master’s degree preferred) with a minimum of 10 years of experience performing advanced health care analysis, or an equivalent combination of education and experience. Society of Actuaries (FSA) required. MBA preferred.

• Must have strong financial acumen coupled with an understanding of the success drivers of a provider-owned health insurance plan
• Previous experience with health care insurance, reserve setting, rate development required
• Experience with MS Windows and MS Office; expert Excel and Access skills required
• Demonstrated leadership experience
• Comfortable working with and presenting to executive leadership
• Analytic, quick learner, self-starter
• Excellent written and oral skills
• Strong project management skills with excellent organizational skills
• Responsive, Energetic, Detail-Oriented, Tactful, Innovative, Complex Thinker, Collaborator, Challenger, Achievement Striving, Driven, Disciplined, Methodical, Problem Solver
• Proven examples of displaying HNE values: Simple, Caring, and Affordable
• Able to communicate with business clients in a language they can understand. Effective at translating complex or technical issues into layman's terms. Is articulate and able to communicate in a compelling manner with customers, peers, and staff alike
• Ability to develop direct report(s)

Working Conditions: Works in a standard office-based environment; non-standard hours are a common occurrence.

• Non-standard business hours may occur, usually preplanned
• Limited travel required

Supervisory Responsibilities:

• Direct: Actuarial and Analytics Manager

Acknowledgement: By signing below, I acknowledge that I have reviewed this role description and understand the key accountabilities of my role. I am able to perform the essential functions as outlined with or without reasonable accommodation. I understand that from time to time, I may be asked to perform duties and handle responsibilities that are not specifically addressed in my job description. I have discussed any questions about this job description with my immediate supervisor or member of the HR staff prior to signing this form.

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