Actuarial Director, Health Economics in USA

Job title: Actuarial Director, Health Economics in USA at PacificSource Health Plans
Company: PacificSource Health Plans
Job description: Looking for a way to make an impact and help people?Join PacificSource and help our members access quality, affordable care!PacificSource is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to status as a protected veteran or a qualified individual with a disability, or other protected status, such as race, religion, color, sex, sexual orientation, gender identity, national origin, genetic information or age. PacificSource values the diversity of our community, including those we hire and serve. We are committed to creating and fostering a work environment in which individual differences and diversity are appreciated, respected and responded to in ways that fully develop and utilize each person’s talents and strengths.Provide actuarial services in the area of health economics. Lead organizational discipline around management of utilization, unit cost, and service intensity. Responsible for accurate and reliable actuarial activities. Ensure sound actuarial analysis of risk, resulting in the attainment of PacificSource's financial and enrollment goals. Work to increase enrollment and maintain a strong financial position. Provide documented input on decisions which impact the risk assumed through various current or proposed activities. Manage and provide leadership and vision to team of analysts. Provide guidance to team members regarding company policies, mandates, and workflow. Oversee hiring, productivity, and quality of the team’s work.Essential Responsibilities:

• Direct health economics strategy. Work with VP/Chief Actuary, Health Services, Provider Network, Actuarial Pricing and other leadership areas to ensure consistency with partnering departments and alignment with company strategy/goals.
• Make documented recommendations based on the analysis of information regarding methods to reduce costs.
• Collaborate with pricing actuaries to ensure actual and/or expected outcomes of health economics programs are reflected in premium rates. Provide actuarially sound pricing assumptions and analysis, including supporting actuarial memoranda where necessary.
• Coordinate business activities by maintaining collaborative partnerships with key departments.
• Actively participate in various strategic and internal committees in order to disseminate information within the organization and represent company philosophy.
• Provide leadership and supervision to a team of actuarial students, credentialed actuaries, and non-actuarial analysts.
• Assist with hiring, staff development, coaching, performance reviews, corrective actions, and termination of employees. Provide feedback, including regular one-on-ones and performance evaluations, for direct reports.
• Provide input into operational and strategic initiatives as they relate to the actuarial functions of the company.
• Participate in the design and execution of research activities performed within PacificSource.
• Responsible for process improvement and working with other departments to improve interdepartmental processes. Work with staff to promote utilization of lean methodologies for continuous improvement throughout the department.
• Directs the assessment of various elements of risk, cost, and utilization, and its financial impact upon PacificSource.
• Responsible for developing the organization's targeted cost and utilization trend through regular and systematic analysis of experience and forecasting of financial and statistical data in a manner that is actuarially sound, competitive in the marketplace, and provides income in accordance with organization goals and objectives.
• Manage the development, implementation, and maintenance of health economics models, coordinating with other departments to ensure compliance with regulatory requirements and consistency with PacificSource policies.
• Assist in the development and monitoring of clinical programs and provider contracts. Product development activities include: proposing program adjustments, creating organizational discipline around the management of cost and utilization trends, modeling risks and recommending provider contract parameters, reviewing draft provider contracts, monitoring accuracy of contract implementation and measuring contract performance, planning and execution of ongoing risk management, and making presentations to senior executive management.
• Stay informed regarding changes to actuarial curriculum and requirements. Propose updates to student program as needed.
• Assist in the development of department budgets.

Supporting Responsibilities:

• Meet department and company performance and attendance expectations.
• Follow the PacificSource privacy policy and HIPAA laws and regulations concerning confidentiality and security of protected health information.
• Perform other duties as assigned.

SUCCESS PROFILEWork Experience: At least six years health actuarial experience and three years management experience required.Education, Certificates, Licenses: Baccalaureate degree in mathematics, statistics, actuarial science, or a related field. Enrolled as an Associate or Fellow in Society of Actuaries, and active member in good standing of American Academy of Actuaries. Fellow in Society of Actuaries preferred.Knowledge: Must possess the knowledge and assume responsibility for performing the functions of the job position. Must perform and be responsible for the functions in a manner which promotes confidence in the person's abilities. Ability to accomplish tasks accurately under pressure, determine priorities, and to meet deadlines. Ability to identify and define problems, design and then implement solutions, and further monitor results, in a continuous cycle. Is creative and innovative in responding to challenges. Ability to apply actuarial methods and modeling techniques. Verifies and documents assumptions, justifies analysis and recommendations with sound logic and actuarial principles, and adheres to Actuarial Standards of Practice.CompetenciesAuthenticityBuilding Organizational TalentCoaching and Developing OthersCompelling CommunicationCustomer FocusEmpowerment/DelegationEmotional IntelligenceLeading ChangeManaging ConflictOperational Decision MakingPassion for ResultsEnvironment: Work inside in a general office setting with ergonomically configured equipment. Travel is required approximately 5% of the time.Skills: Accountable leadership, Business & financial acumen, Empowerment, Influential Communications, Situational Leadership, Strategic PlanningOur ValuesWe live and breathe our values. In fact, our culture is driven by these seven core values which guide us in how we do business:

• We are committed to doing the right thing.
• We are one team working toward a common goal.
• We are each responsible for customer service.
• We practice open communication at all levels of the company to foster individual, team and company growth.
• We actively participate in efforts to improve our many communities-internally and externally.
• We actively work to advance social justice, equity, diversity and inclusion in our workplace, the healthcare system and community.
• We encourage creativity, innovation, and the pursuit of excellence.

Physical Requirements: Stoop and bend. Sit and/or stand for extended periods of time while performing core job functions. Repetitive motions to include typing, sorting and filing. Light lifting and carrying of files and business materials. Ability to read and comprehend both written and spoken English. Communicate clearly and effectively.Disclaimer: This job description indicates the general nature and level of work performed by employees within this position and is subject to change. It is not designed to contain or be interpreted as a comprehensive list of all duties, responsibilities, and qualifications required of employees assigned to this position. Employment remains AT-WILL at all times.
Expected salary:
Location: USA
Job date: Sat, 26 Apr 2025 07:13:05 GMT
Apply for the job now! [ad_2] Apply for this job