Actuary (Medicare Advantage)

Description

The Actuary is expected to hold Actuarial finance responsibilities, including forecasting cash flow and capital requirements, influence reinsurance strategies, monitor financial trends in the industry, and interact with external stakeholders (regulators, investors, etc.) as necessary to communicate actual and projected performance. The Actuary will also support or take responsibility for additional actuarial processes including regulatory financial pro forma projections, supporting the annual Medicare Advantage and Part D bids, forecasting, and a variety of ad hoc analyses to support business decision making. The ideal candidate will possess an intellectual curiosity and passion to move the business forward through insightful analyses.

What’s in it for you?

1. A competitive compensation and benefits program
2. Stock options
3. 15% Annual Incentive Plan bonus
4. Flexibility to work remotely
5. Generous 15 days of paid-time-off (PTO)
6. Eleven (11) paid holidays per year
7. Excellent 401k saving plan, employer provides up to 4% match and employer contribution match is 100% immediately vested

Functions & Job Responsibilities

• Forecasting required capital requirements by entity, ensuring accurate risk based capital (RBC) reporting, forecasting cash flow and regulated cash balances.
• Interact with external stakeholders (e.g., regulators, investors, network partners, vendors, etc.), to communicate actual and expected performance, consistent with our commitment to regulatory hyper-compliance.
• Provide expertise and consultation and/or create policies and procedures to advance capabilities in organizational pricing (MA & Part D), reserving, budgeting/forecasting, benefit design, provider contracting, risk adjustment, regulatory reporting, pharmacy benefits management, population health, provider reimbursement, enterprise risk management, and/or financial performance management.
• Comply with requirements for Actuarial Opinions related to the annual financial statements, as well as various actuarial analyses as covered by the Actuarial Standard of Practices.
• Develop and maintain knowledge and expertise in regional and national managed health care trends and best practices, seeking opportunities to translate those to Clever Care.
• Provide insight to all key, organizational, financial arrangements, including many non-actuarial arrangements.
• Collaborate with senior management and business staff to prepare key financial statements and projections, including budget, forecasts, and monthly statements.
• Support inputs, assumption setting, and actuarial product strategy for the annual CMS Medicare Advantage and Part D bids.
• Support official communications with external audiences, including network partners, regulators, and/or investors.

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Qualifications

Required Qualifications

• Bachelor’s Degree in Actuarial Science, Economics, Mathematics or other related field
• Seven (7) years of relevant actuarial experience in Medicare Advantage.
• Associate or Fellow of the Society of Actuaries, and Member of the American Academy of Actuaries required.
• Experience in Medicare Advantage is required, including understanding of the annual bid, risk adjustment, and provider reimbursement.
• Proficiency in all aspects of statutory health care actuarial practice including pricing, reserving, and data reporting.
• Experience in actuarial valuation, specifically in health plan corporate finance and reserve setting.
• Broad understanding of managed care business and financial principles such as capital management, underwriting, medical management, physician reimbursement, and risk management.
• Proven capabilities in modeling, forecasting, and predictive analytics
• Strong communication and presentation skills; written/verbal proficiency.

• Must be analytical, hands on, and able to be a contributor on day one.
• Strong actuarial functional expertise with an understanding of the key financial drivers of Medicare Advantage health plan operations.
• Strategic ability to understand the business at large and connect points across mathematical and financial relationships across the organization.
• Ability to operate in an ambiguous start-up environment where every day we try to develop and optimize our operations.
• Maintain high ethical standards at all times, to include maintaining the confidentiality of financial and other sensitive information consistent with moral, professional, and regulatory requirements.

Physical & Working Environment.

Physical requirements needed to perform the essential functions of the job, with or without reasonable accommodation:

• Must be able to travel when needed or required
• Ability to operate a keyboard, mouse, phone and perform repetitive motion (keyboard); writing (note-taking)
• Ability to sit for long periods; stand, sit, reach, bend, lift up to fifteen (15) lbs.

Ability to express or exchange ideas to impart information to the public and to convey detailed instructions to staff accurately and quickly.

Work is performed in an office environment and/or remotely. The job involves frequent contact with staff and the public. May occasionally be required to work irregular hours based on the needs of the business.

Clever Care Health Plan is proud to be an Equal Employment Opportunity and Affirmative Action workplace. Individuals seeking employment will receive consideration for employment without regard to race, color, national origin, religion, age, sex (including pregnancy, childbirth or related medical conditions), sexual orientation, gender perception or identity, age, marital status, disability, protected veteran status or any other status protected by law. A background check is required.

Salary ranges posted on the job posting are based on California wages. Salary may be higher or lower depending on the candidate’s state residency.

Salary : $200,000 - $230,000