Senior Actuary

• Preparing, analyzing and reporting accurate pricing and financial analysis to develop actuarially sound rates.
• Leading/attending meetings to discuss impact of rates and assumptions, and participate in the decision process for rating actions for these products.
• Advising other departments (Underwriting, Marketing and Finance, etc.) on the pricing and profitability of these products.
• Assist with recruiting and, training actuarial staff to build a high performing actuarial team.

• Market/Product Performance Management
• Effectively monitor and analyze the experience of our products and make recommendations for improvements.
• Provide actuarial support to product development in evaluating benefit design changes and developing new products.
• Effectively communicate to senior management on important actuarial recommendations.
• Leading/attending meetings to discuss impact of pricing and assumptions and participate in the decision process for rating actions for these products.

• Review, and evaluate data, financial statements, process documentation, and reports from across the enterprise that impact plan finance to understand any root causes or specific areas of concern. Based upon this review and assessment, would pinpoint the area(s) causing the issues and would provide management some actionable initiatives or corrective actions that could be undertaken to cure some of the financial strain.
• Margins, trends, ROI where actuarial analyses are needed (pre contract signature and post evaluation)

• Collaboratively build or enhance an analytic framework that affords continuous measurement and evaluation of past decisions and timely profitability analyses.
• Perform analyses of profitability by county/region to identify potential issues that could identify further risks related to provider contracting, utilization, plan design, or high-risk members.
• Product benefit and MLR Optimization
• Monitor and evaluate MLRs exceeding 90% (cost of care on a per-member-per-month (“PMPM”) costs over time are increasing faster than increases in PMPM revenue)
• Advising other departments (Underwriting, Marketing and Finance, etc.) on the pricing and profitability of these products.

• Extensive experience and expertise working with healthcare data in support of key policy initiatives, including establishing and manipulating large healthcare claims and enrollment datasets, developing, and maintaining reporting programs and structures, and marshaling sophisticated analytics in support of key policy and strategic decision-making. From medical claims, enrollment, and premium and budget data to enrollee demographics and operational metrics, needs to be highly proficient in manipulating data, interpreting trends, and, most importantly, using data to create meaningful and actionable information. Experience presenting information to internal staff, senior leaders, boards of directors, and legislative and stakeholder groups.
• Direct and complete periodic trend analysis review, identify drivers, and present opportunities for company’s products.
• Creates actionable information on specific groups of members, providers and operational programs that influence financial performance.
• Disciplined and transparent analytic work, assessment of options, creative problem-solving, attention to deadlines, and clear communication and documentation of complex issues.

Primary Location

SITE - Priority Health - 1241 E Beltline - Grand Rapids

Department Name

PH - Executive Actuarial

Employment Type

Full time

Shift

Day (United States of America)

Weekly Scheduled Hours

40

Hours of Work

8 a.m. to 5 p.m.

Days Worked

Monday to Friday

Weekend Frequency

N/A

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Corewell Health is committed to providing a safe environment for our team members, patients, visitors, and community. We require a drug-free workplace and require team members to comply with the MMR, Varicella, Tdap, and Influenza vaccine requirement if in an on-site or hybrid workplace category. We are committed to supporting prospective team members who require reasonable accommodations to participate in the job application process, to perform the essential functions of a job, or to enjoy equal benefits and privileges of employment due to a disability, pregnancy, or sincerely held religious belief.

Corewell Health grants equal employment opportunity to all qualified persons without regard to race, color, national origin, sex, disability, age, religion, genetic information, marital status, height, weight, gender, pregnancy, sexual orientation, gender identity or expression, veteran status, or any other legally protected category.

An interconnected, collaborative culture where all are encouraged to bring their whole selves to work, is vital to the health of our organization. As a health system, we advocate for equity as we care for our patients, our communities, and each other. From workshops that develop cultural intelligence, to our inclusion resource groups for people to find community and empowerment at work, we are dedicated to ongoing resources that advance our values of diversity, equity, and inclusion in all that we do. We invite those that share in our commitment to join our team.

You may request assistance in completing the application process by calling 616.486.7447.