Company Statement

EmblemHealth is one of the nation’s largest not for profit health insurers, serving members across New York’s diverse communities with a full range of commercial and government-sponsored health plans for employers, individuals, and families. With a commitment to value-based care, EmblemHealth partners with top hospitals and doctors, including its own AdvantageCare Physicians, to deliver quality, affordable, convenient care. At over a dozen EmblemHealth Neighborhood Care locations, members and non-members alike have access to community-based health and wellness guidance and resources. For more information, visit emblemhealth.com.

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AVP, Actuary-Government Business

🔍 New York, New York

New

💼: EmblemHealth

📅   : 1 day ago Post Date

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).

Security Disclosure

If you receive a job offer from EmblemHealth, the email will be from “HRTalentAcquisition” with the subject: “Offer of Employment for (job title) – Please respond online.” We will never ask you to join a Google Hangout, buy your own equipment, or pay to apply. We also do not use third-party email services like Yahoo or Gmail.

Pay Disclosure

At EmblemHealth, we prioritize transparency in our compensation practices. We provide a good faith estimate of the salary range for potential hires, which is based on key factors such as role responsibilities, candidate experience, education and training, internal equity, and market conditions. Please be aware that this estimate doesn’t account for geographic differences related to your work location. Typically, new hires may not start at the top of this range, as compensation is tailored to each individual's circumstances. For union positions, salaries will be determined according to the collective bargaining agreement. Join us at EmblemHealth, where your contributions are valued and supported by fair compensation.

EEOC Statement

We value the diverse backgrounds, perspectives, and experiences of our workforce. As an equal opportunity employer, we consider all qualified applicants for employment regardless of race, color, religion, sex, sexual orientation, gender identity, pregnancy, marital status, national origin, disability, veteran status, or any other protected characteristic protected by law.

Sponsorship Statement

At EmblemHealth, we are committed to building a diverse and talented workforce. However, we are unable to consider applicants who require, or are likely to require, either before or after hire, visa sponsorship for work authorization in the United States, including but not limited to H-1B, F-1 (STEM OPT), TN, or any other non-immigrant status. Some extremely rare exceptions may apply based on critical business needs.