We are seeking a highly skilled and experienced professional to join our client's team as the Director of Actuarial Services, specializing in the Medicare space. The successful candidate will play a pivotal role in overseeing actuarial functions related to Medicare Advantage, bids, Stars, and risk adjustment. This leadership position requires a strategic thinker with a deep understanding of actuarial principles, Medicare programs, and a proven track record in driving successful outcomes in the complex healthcare landscape.
Responsibilities:
Medicare Advantage Oversight:
- Lead and manage actuarial teams responsible for the development and maintenance of Medicare Advantage pricing models.
- Analyze market trends, regulatory changes, and competitor strategies to ensure our Medicare Advantage offerings remain competitive and compliant.
Bid Strategy and Development:
- Collaborate with cross-functional teams to develop comprehensive and accurate bids for Medicare Advantage programs.
- Ensure the accuracy of pricing assumptions, risk adjustments, and financial projections in bid submissions.
Stars Rating Optimization:
- Implement and oversee strategies to improve and maintain high Stars ratings for Medicare Advantage plans.
- Collaborate with operational teams to identify and address areas for performance improvement that impact Stars ratings.
Risk Adjustment Management:
- Develop and implement robust risk adjustment models to accurately reflect the health status of Medicare Advantage members.
- Collaborate with data analytics teams to identify opportunities for improvement in risk adjustment processes.
Regulatory Compliance:
- Stay abreast of changes in Medicare regulations, guidelines, and policies to ensure compliance in all actuarial practices.
- Work closely with legal and compliance teams to address regulatory challenges and implement solutions.
Cross-functional Collaboration:
- Foster strong partnerships with cross-functional teams, including finance, operations, compliance, and product development, to align actuarial strategies with overall business objectives.
Talent Development:
- Recruit, mentor, and develop a high-performing actuarial team.
- Provide guidance and support for professional development to ensure the team stays at the forefront of industry best practices.
Qualifications:
- Bachelor's degree in Actuarial Science, Mathematics, Statistics, or related field. Advanced degree or professional certification (FSA, ASA) preferred.
- Minimum of [X] years of experience in actuarial roles within the Medicare space, with a focus on Medicare Advantage.
- In-depth knowledge of actuarial principles, healthcare financing, and regulatory landscape.
- Strong analytical and problem-solving skills with the ability to translate complex actuarial concepts into actionable strategies.
- Excellent communication and leadership skills, with the ability to influence and collaborate across departments.
- Proven track record of successful bid submissions
If you are a dynamic and strategic thinker with a passion for shaping the future of healthcare through actuarial excellence, we invite you to apply for this challenging and rewarding leadership role. Join us in making a meaningful impact on the Medicare landscape!
