Director and Senior Actuary, Public Plans

Company: Fallon Community Health Plan
Location: Worcester
Posted on: November 22, 2021

Job Description:

Director and Senior Actuary, Public PlansUS-MA-WorcesterJob ID: 6572Type: Full Time# of Openings: 1Category: FinanceFallon Health - Corp HQOverviewAbout Fallon HealthFounded in 1977, Fallon Health is a leading health care services organization that supports the diverse and changing needs of those we serve. In addition to offering innovative health insurance solutions and a variety of Medicaid and Medicare products, we excel in creating unique health care programs and services that provide coordinated, integrated care for seniors and individuals with complex health needs. Fallon has consistently ranked among the nation's top health plans, and is accredited by the National Committee for Quality Assurance for its HMO, Medicare Advantage and Medicaid products. For more information, visit fallonhealth.org. Brief summary of purpose: The Public Plans team within the Actuarial Department provides support to Product and Executive Leadership to improve plan performance through profitability and membership growth. ResponsibilitiesThe Actuary serving as Director & Sr. Actuary, Public Plans is responsible for providing actuarial support for the following products: Medicaid and Community Care.Specific responsibilities will include: Support regulatory filings and management decisions for these products, including but not limit to: financial reporting to MassHealth, settlements with ACO partners, preparing Merged Market rate filings and MLR filings, reviewing annual CSR submissions and reconciliations, and providing audit support for these products, as needed.Effectively communicate strategic options and results to leadershipWork with Product Management to monitor experience and to develop and analyze strategies to maximize revenue and optimize financial resultsConduct actuarial studies, develop, recommend actions to senior leadership and assist in the implementation to improve plan performance program wideReview actuarial assumptions, pricing methodologies and assist leadership in strategic and tactile decision making. Work on negotiations and lobbying for important business/product changes.Review actuarial assumptions, pricing methodologies and assist leadership in strategic and tactile decision making. Work on negotiations and lobbying for important business/product changes.Analyze competitive information from other departments within FCHP in order to keep apprised of local and industry trendsAssist and analyze competitive data to drive our business objectivesStay informed of national and local trends regarding product and provider changesStay informed of federal and state legislative changesThis role requires good communication with Sr. Management as well as the Actuarial, Finance, Operations, Sales, Clinical and Product teams to understand and model the most relevant factors, highlight risks and opportunities that exist, recommend actions to Senior Leadership and assist in their implementation to improve plan performance - profitability and membership growth. Staff management responsibilities include training and developing staff, reviewing their work, and monitoring adherence to department and actuarial standards for quality, accuracy, and collaboration.QualificationsEducationB.A./B.S. degree, preferably in Mathematics, Finance, Economics, or related field License/Certifications:ASA or FSA Experience:10+ years of responsible health plan actuarial experience, including at least 5 years of actuarial experience in valuation and forecasting. The ideal candidate must possess: Highly-developed oral and written communication skillsAbility to effectively present to highest level of company managementAbility to integrate across department functions and several business functionsAbility to effectively manage difficult group dynamicsAbility to work congenially and collaboratively with department staff and business partnersAbility to influence decisions at management and senior management levelsAbility to implement Actuarial department standards and processesAbility to develop and lead the execution of business processesAbility to translate corporate and department goals into specific initiativesAbility to influence the development of future corporate and department goal setting Ability to direct a broad set of business processes and initiatives with accountability quality and accuracy of results Fallon Health provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.PI154381248

Keywords: Fallon Community Health Plan, Worcester , Director and Senior Actuary, Public Plans, Accounting, Auditing , Worcester, Massachusetts