This position leads key segment strategies related to Dean Health Plan's Government Program (Medicare and Medicaid) lines including Actuarial, Pricing, Financial and Experience Management functions. This leader drives the company's strategic business objectives, goals/budgeting, and segment initiatives. Directs and manages a direct/indirect team to prepare all pricing and advanced analytic analysis, including financial experience, trend analysis, and risk studies. Works collaboratively with company leaders to develop and support business objectives. Provides direction, leadership and growth to employees and others within the company. Actively participates in committees pertaining to a wide scope of projects.
Essential Job Duties:
To successfully perform this job, the individual must be able to perform each essential job responsibility satisfactorily. Reasonable accommodations may be made to enable an individual with disabilities to perform the essential job responsibilities.
Leader of Government Program Segment (Medicaid, Medicare Cost, and new Medicare Advantage) pricing efforts related to current and future products. Develop annual pricing analysis with quarterly experience analysis supporting a management review discussion and implementation of go forward pricing decisions. Oversee and peer review the development of company rate filings, including underlying pricing factors.
Member of Product Development and Implementation team for Medicare Advantage launch in 2016. Owns product/plan designs, pricing, and administrative budget for this market launch in 2016 and subsequent launches in other SSM markets (timing TBD).
Lead detailed analytic analysis including trend and book of business reporting for Government Programs. Publish reports and hold stakeholder review meetings periodically (at least quarterly) analyzing cost data and book of business experience trends. Work with inter-departmental team to identify and track cost management opportunities.
Ownership and accountability for product analysis, reporting, price point forecast development, experience analysis and related changes/results with recommendations and communications to Senior Leadership/Governance Committee: (a) Oversee monthly book of business and actual to expected variance analysis working with the team, providing ad-hoc analysis on trends and variances (b) Provide information to Finance and other management on product level experience; (c) Oversee preparation of regulatory rate filings, including coordinating with regulatory authorities to obtain approval; (d) Develop, maintain and oversee implementation of rating plans, integrating with contracting, medical management, Sales and senior leadership; (e) Coordinate rating system updates with Underwriting; oversee appropriate checks and balances for implementation of rates
Be an active leader on the Product Strategy Team(s) supporting product vision, strategies, innovation and related initiative ownership. Assist with the analysis and development of new products/markets (including Dean Export), services and delivery system changes identified from Product Team strategies. Assist with developing product, pricing and value proposition strategies with collaboration with Sales, Medical Management, Product Management and Provider Contracting.
Select, develop, motivate, train and retain a competent staff to ensure appropriate staffing resources
Incorporate risk score reporting into member on boarding and care management initiatives and align to revenue optimization for Medicare Advantage.
Provides support to DHP periodic monthly forecasting and annual budgeting process related to claims and premium projections.
Provide staff management and mentoring support for the department.
Acts as a change agent for the organization by leveraging knowledge base and experience to business decisions and transformational change needed by DHP.
Develop and maintain actuarial standards and methodologies into departmental processes. Ensures maintenance of current policy and procedure documents (including MAR) for the department.
Perform other special assignments, as requested.
A Bachelor's Degree in Actuarial Science, Statistics, Mathematics, Economics, Finance or other Business related function.
Minimum of seven (7) years of health insurance related work are required, including at least five (5) years of experience in a managed care setting.
Minimum of five (5) years of Senior Market experience (Medicare Supplement; Medicare Advantage)
Strong statistical modeling, data modeling, and organizational skills.
Strong systems skills; ability to define actuarial data requirements.
Strong written and oral communication skills.
Prior supervisory experience.
Experience with capitation/risk pools, government programs and a physician sponsored health plan.
Ability to present actuarial analyses to non-actuarial audiences.
You’ve known us as many names throughout St. Louis, and now, we’re bringing our hospitals, doctors, home care and other services together under one name – SSM Health. With seven hospitals, 350+ physicians, more than 40 physician locations and 12,000 employees, we are part of something bigger and better. We’re connected to a wealth of resources, expertise and advance technology to help you, your fa...mily and our community live long, healthy lives.
We’ve grown and changed a lot over our 143-year history. Our name may be changing but our mission remains the same