DIRECTOR- ACTUARIAL SERVICES

For a 4^th year in a row, Aspirus has been recognized as one of the top 15 Top Health Systems in the United States by IBM Watson in their annual study identifying the top-performing health systems in the country based on overall organizational performance.

We are seeking a DIRECTOR – OPERATIONS AND ACTUARIAL ANALYTICS in Wausau or Madison, Wisconsin. Reporting directly to the President of AHP, the Director of Actuarial Services is responsible for overseeing all actuarial and underwriting functions for Aspirus Health Plan (AHP).  This position oversees all pricing activities including rate factors, formulas, and claims statistics for both community-rated and experience-rated insured customers to establish financially sound and adequate premium rates; coordinates the submission of Medicare Advantage bids, monitors the performance of the contracted underwriting services firm; performs data analytics and reporting to identify opportunities to improve medical spend trend; and leads risk adjustment optimization work.

PRINCIPAL DUTIES AND RESPONSIBILITIES:

ACTUARIAL

• Monitor financial results vs expected, proposing corrective actions when needed.
• Assess trends and incorporate them into future projections.
• Lead actuarially based product development activities.
• Evaluate and recommend changes when needed in the organization’s rate structure and advise management on pricing arrangements necessary under customer contracts.
• Direct the calculation and maintenance of rating factors for all AHP products.
• Review and approve monthly claim reserves used for financial reporting.
• Review, interpret, analyze, and communicate financial reports and data to management and various Board of Directors
• Provide strategic support and guidance to senior management and the Board of Directors in making key business decisions.
• Develops and maintains strong relationships with vendors supporting actuarial services, while holding accountable for the delivery upon their contractual commitments.

UNDERWRITING

• Develops and maintains strong relationships with contracted underwriting services firm, while holding accountable for the delivery upon their contractual commitments.
• Develop and communicate strategic goals to the team regarding the targeting of new business.
• Review all quotes for new groups that are considered strategic accounts.
• Make recommendations on negotiated new business quotes on large groups above $2.5M in annual premium.
• Review and approve rate levels for all large group renewals.
• Develop new and maintain existing relationships with external stop loss carriers.

REPORTING & DATA ANALYTICS

• Lead quarterly Aspirus Health Plan meetings reviewing health plan results and trends
• Review existing reporting platforms on an annual basis, determining if they are meeting our corporate needs, and recommend changes as necessary.
• Analyze Underwriting database information to improve close ratios and modify our strategy for sales and retention
• Support key large accounts by directing the creation of customized claim driver reports and assist in the presentation of the data to groups (including eHP).

RISK ADJUSTMENT

• Maintain and enhance HCC gap closure projects across the Aspirus Health, as well as non-Aspirus providers.
• Lead an ongoing project of incorporating vendor HCC gap closure information into Aspirus processes for ACA and MA members.
• Coordinate regular use of the Aspirus EMR into HCC capture processes.
• Support the RADV (audit) process.
• Monitor EDGE server submission for accuracy and completeness.

Education

• Bachelor's degree in Actuarial Science, Mathematics, or related field required.
• Actuarial Credentials (ASA) required; FSA preferred

Aspirus Health Plan (AHP) is a wholly owned health plan subsidiary of Aspirus, Inc. and has profitably grown to over 30,000 lives since January 2017.   Aspirus Health Plan (AHP) is a wholly owned health plan subsidiary of Aspirus, Inc. and has profitably grown to over 45,000 lives since its inception in 2016.  AHP offers products to individuals (on and off exchange), small group (off exchange), large group, Medicare Advantage, and provides administrative services for self-funded plans.

Hours: Full time Benefit package available, 80 Hours per pay period, Day Shift. Ability to work from Wausau or Madison, WI.

Aspirus is a non-profit, community-directed health system based in Wausau, Wis. With more than 8,700 employees, Aspirus serves communities in northern and central Wisconsin and Upper Michigan. The system includes four hospitals in Michigan and six hospitals in Wisconsin, 50 clinics, home health and hospice care, pharmacies, critical care and helicopter transport, medical goods, nursing homes, high-quality affiliated physicians and a health insurance company.

As an Aspirus team, we demonstrate caring, we plan to impact the future, work with happiness and enthusiasm, recognize our power to make a difference and improve the health of our communities.

Click on the following links:    Learn more about Wausau click here: Wausau, Wisconsin