Summary of Position
- Oversee development of pricing models and their use in product strategy for Medicare and State-Sponsored Program (SSP)
lines of business. - Lead Enterprise Government Actuarial Areas, which includes 400,000-500,000 lives, representing over $2.5 billion in revenue.
- Key influencer and driver of Medicare and SSP strategy.
- Responsible for Enterprise Medicare bid filings, Employer Group medical pricing, Medicare Supplement Pricing, SSP Premium
analytics, budgeting, reporting, and financial performance tracking. - Support risk adjustment team, including forecasting revenue, monitoring and valuing activities, and reporting.
Principal Accountabilities
- Support and influence multi-year strategy development for Government business.
- Responsible for development and accuracy of Medicare pricing/budget assumptions in support of strategy, including
new and existing Medicare plans. - Support management of segment action plans to achieve margin targets
- Responsible for the oversight of the filing of Medicare Advantage bids.
- Oversee development and filing of premium rates for all products with the appropriate regulatory authority (e.g.,
CMS, New York Department of Health). - Manage and develop a high-performing Actuarial team.
- Monitor progress on individual goals, provide support on individual development plans, and proactively plan for
growth and succession. - Manage analysis of underlying business performance for Government business lines.
- Fulfill SSP filing requirements defined by regulatory entities such as SCMS and DOH.
- Collaborate with segment leadership, Finance, HCE, and other teams to develop accurate forecasts.
- Design & develop standard reports to meet the needs of government programs and other leaders.
- Key point of contact for enterprise government plan analytics.
- Anticipate and identify key source information to analyze problems clearly, identify root causes, trends and
opportunities, determine creative solutions. - Provide Support to Medicare Product and Account Management areas through analyzing and improving financial
performance, including risk adjustment coding accuracy to achieve targeted profitability
Qualifications Education, Training, Licenses, Certifications
- Bachelor's degree in Actuarial Science, Mathematics, Economics, or similar major.
- Fellow of the Society of Actuaries strongly preferred.
Relevant Work Experience, Knowledge, Skills, and Abilities
- 15+ years of actuarial experience with ASA; or 12+ years' experience with FSA.
- 10+ years health insurance actuarial experience, preferably in Medicare.
- Ability to analyze complex health insurance issues such as risk modeling, impact of provider contracting changes, etc.
- Strong understanding of actuarial principles & methodologies related to Medicare Advantage pricing and product design.
- Understanding of government benefits and design.
- Proven track record of successfully overseeing multiple large (company/divisional) projects.
- Strong organizational skills and ability to prioritize and successfully manage multiple priorities/deadlines.
- Strong management and leadership skills - ability to develop and motivate staff.
- Excellent written and verbal communicator - need to be able to summarize complex analyses succinctly and be able to
present results to senior management and others effectively. - Executive presence; comfortable speaking with all organizational levels, within and external to, the company.
- Proficient with MS Office (Word, Excel, Access, PowerPoint, Outlook).
Additional Information
- Requisition ID: 1000002591
- Hiring Range: $162,000-$302,400
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EmblemHealth
Jul 17, 2025