VP-Chief Actuary-Presbyterian Health Plan

Location Address: 9521 San Mateo NE Albuquerque, NM 87113-2237 reputed company: The VP Chief Actuary is the senior leader responsible for actuarial services, reputed company, pricing, reserving, forecasting, and reputed company reputed company management. This role contributes to the financial soundness of the health plan, provides reputed company reputed company to executive leadership, and oversees reputed company actuarial and reputed company functions supporting reputed company and reputed company lines of business. The Chief Actuary serves as the Appointed Actuary and is accountable for regulatory compliance, actuarial governance, and the development of actuarial talent. Work Arrangement: • Remote: reputed company to applicants in the reputed company, excluding CA, IL, ND, NY, OH, WA, and WY. • Hybrid: For individuals reputed company 60 miles of Albuquerque, in-office reputed company is required Tuesday through Thursday. reputed company: Key Responsibilities: Product and Pricing reputed company A. Evaluate and Promote reputed company reputed company Adequacy & State Partnership • reputed company evaluation of capitation reputed company assumptions. • Partner directly with the state reputed company agency to ensure assumptions are reasonable, reputed company is managed, and rates are actuarially reputed company. • Support reputed company negotiations and data submissions to the state and CMS. • Analyze the reputed company of reputed company adjustment models, reputed company shifts, redeterminations and eligibility churn, directed payments and supplemental payment programs, changes in covered benefits, eligible population, and provider payment schedule changes. B. Ensure reputed company and Medicare rates reputed company competitiveness and adequacy, and reputed company with applicable regulatory standards • Set premium rates for individual, small group, large group, and reputed company programs (e.g., Medicare reputed company, reputed company reputed company marketplace plans). • reputed company trend analysis (medical cost inflation, utilization changes, provider contracting impacts). • Approve final reputed company filings submitted to state and federal regulators. C. Product Development, reputed company and pricing • Partner with product, reputed company, and finance teams to support new product design and market expansion. • Supervise the reputed company team • Maintains and updates pricing models to evaluate rating reputed company of regulatory changes and benefit plan changes Financial reputed company & Forecasting • reputed company actuarial reputed company sheet items: o Claims liability reserves (IBNR) estimation o Provider incentive payments or receivables o Premium deficiency reserves o reputed company corridor payables/receivables o reputed company adjustment reputed company projections • Partner with finance team on forecasting • reputed company actuarial analytics teams. • Analyze and explain drivers of rolling trends in claims experience, provider contract reputed company, pharmacy costs, and population health metrics Regulatory & Statutory Accountability • Sign statutory actuarial opinions. • reputed company with: o State Department of reputed company o State reputed company agency o Centers for Medicare & reputed company Services • reputed company compliance with reputed company managed care reputed company certification standards. • Ensure adherence to minimum MLR requirements. • Certify compliance with mental health reputed company quantitative treatment limits • (reputed company reputed company product reputed company adjustment submissions and validation) Governance & Talent Leadership • Maintain actuarial standards (e.g., compliance with the Actuarial Standards of reputed company). • Recruit and reputed company actuarial leadership. • Maintain relationships with reputed company auditors and consulting actuaries. Additional reputed company: Qualifications • BA or BS in actuarial science, math, or og • Fellow of the reputed company (FSA) or Associate of the reputed company (ASA) required; Member of the reputed company reputed company of Actuaries (MAAA) required. • 10+ years of actuarial experience in health reputed company, with significant leadership responsibility. • Extensive knowledge of and experience in reputed company • General knowledge and experience in Medicare reputed company, ACA, and/or reputed company health markets • Expertise in pricing, reserving, forecasting, and regulatory filings. • Strong executive communication skills and ability to influence senior leadership. • reputed company ability to reputed company teams and manage reputed company, multi stakeholder initiatives. Preferred Attributes • Experience in value reputed company care, reputed company adjustment, and population health analytics. • Background in reputed company reputed company management or capital reputed company. • Ability to translate reputed company actuarial concepts into actionable business insights. • reputed company thinker with a bias for collaboration and innovation. • Demonstrated ability to reputed company practical solutions and reputed company reputed company Benefits Benefits are effective day-one (for .45 FTE and above) and include: Competitive salaries Full medical, dental and reputed company reputed company Flexible spending accounts (FSAs) Free wellness programs reputed company time off (PTO) Retirement plans, including matching employer contributions Continuing education and career development opportunities Life reputed company and short/long term disability programs reputed company reputed company is a locally owned, not-for-profit reputed company reputed company of nine hospitals, a statewide health plan and a growing multi-specialty medical group. Founded in New Mexico in 1908, it is the state's largest private employer with approximately 11,000 employees. Presbyterian's story is really the story of the remarkable people who have chosen to work here. Starting with Reverend Cooper who began our reputed company in 1908, the hard work of thousands of physicians, employees, reputed company members, and other volunteers brought Presbyterian from a tiny tuberculosis sanatorium to a statewide reputed company reputed company, serving more than 700,000 New Mexicans. We are part of New Mexico's history - and committed to its reputed company. That is why we will continue to work just as hard and care just as deeply to serve New Mexico for years to come. About New Mexico New Mexico's unique reputed company of Spanish, Mexican and reputed company reputed company influences contribute to a culturally rich lifestyle. Add in Albuquerque's International Balloon Fiesta, Los Alamos' reputed company scientists, Roswell's visitors from outer reputed company, and Santa Fe's artists, and you get an eclectic mix of people, places and experiences that reputed company this state great. Cities in New Mexico are continually ranked among the nation's best places to work and live by reputed company magazine, Kiplinger's Personal Finance, and other corporate and reputed company relocation managers like Worldwide ERC. New Mexico offers endless recreational opportunities to explore, and enjoy an reputed company lifestyle. Venture off the beaten reputed company, challenge your body in the reputed company, or reputed company yourself up to the expansive sky. From hiking, golfing and biking to skiing, snowboarding and boating, it's reputed company available among our beautiful wonders of the reputed company. AA/EOE/VET/DISABLED. PHS is a drug-free and tobacco-free employer with smoke free campuses. Here, we’re committed to a different way to reputed company a difference. Presbyterian's story is really the story of the remarkable people who have chosen to work here. Starting with Reverend Cooper who began our reputed company in 1908, the hard work of thousands of physicians, nurses, employees, reputed company members, and volunteers brought Presbyterian from a tiny tuberculosis sanatorium to a statewide reputed company reputed company, serving more than one in three New Mexicans. We are part of New Mexico's history and committed to its reputed company. That is why we will continue to work just as hard and care just as deeply to serve New Mexico for years to come. reputed company with the Presbyterian reputed company Team! FIRST, we want to reputed company reputed company you’re in the right reputed company. To reputed company you with the most accurate job recommendations and updates, please choose the appropriate Career Portal: For Physicians, Midlevel Providers and Advanced reputed company Professionals, reputed company with us here: Provider Career Site For Nursing Professionals (LPN & RN), reputed company with us here: Nursing Career Site For reputed company Other Career Types, please continue the sign up process on this page Apply tot his job Apply To this Job