Lead Actuary - Medicaid Trend Quantification

Humana Lead Actuary - Medicaid Trend Quantification Santa Fe , New Mexico Apply Now Become a part of our caring community and help us put health first
The Lead Actuary, Analytics/Forecasting analyzes and forecasts financial, economic, and other data to provide accurate and timely information for strategic and operational decisions.
Establishes metrics, provides data analyses, and works directly to support business intelligence.
Evaluates industry, economic, financial, and market trends to forecast the organization's short, medium and long-term financial and competitive position.
The Actuary, Analytics/Forecasting works on problems of diverse scope and complexity ranging from moderate to substantial.
The Lead Actuary, Analytics/Forecasting ensures data integrity by developing and executing necessary processes and controls around the flow of data.
Collaborates with stakeholders to understand business needs/issues, troubleshoots problems, conducts root cause analysis, and develops cost effective resolutions for data anomalies.
Advises executives to develop functional strategies (often segment specific) on matters of significance.
Exercises independent judgment and decision making on complex issues regarding job duties and related tasks, and works under minimal supervision, Uses independent judgment requiring analysis of variable factors and determining the best course of action.
Additional
Responsible for monitoring emerging medical, pharmacy, and LTSS claims compared to forecast and revenue.
Meets with Market Actuaries and Market CFOs monthly to review sources of emerging unfavorable trend and determining where there is opportunity for mitigation.
Responsible for quantifying and explaining the 'why' of where trends are unfavorable to budget and rate development and advising whether this is a rate issue for negotiation or a claims issue for operational initiatives.
Responsible for ROI analyses for new operational initiatives; this includes quantifying the expected financial outcomes of new vendors and programs; may meet with external vendors as needed to discuss ROIs.
Provides guidance to Controller for month close related to membership and claims impacts to emerging MER and trend.
Responsible for informing the budget spread by claim type and by month.
Supports quantification of budget forecasts where internal experience is expected to differ from rate development.
Use your skills to make an impact
Required Qualifications
Bachelor's Degree
FSA or ASA plus relevant advanced degree, recent and relevant work experience, and/or other relevant professional designations.
MAAA
Experience in more than two functions (e.g., modeling, pricing, rate filing, reporting & analysis, reserving or trending)
Preferred Qualifications
Experience with Power BI a plus
Experience with Medicaid a plus
Scheduled Weekly Hours
40
Pay Range
The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting.
The pay range may be higher or lower based on geographic location and individual pay decisions will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.$126,800 - $174,500 per yearThis job is eligible for a bonus incentive plan.
This incentive opportunity is based upon company and/or individual performance.
Description of Benefits
Humana, Inc.
and its affiliated subsidiaries (collectively, 'Humana') offers competitive benefits that support whole-person well-being.
Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work.
Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.
About us
Humana Inc.
(NYSE:
HUM) is committed to putting health first - for our teammates, our customers and our company.
Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health - delivering the care and service they need, when they need it.
These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.
Equal Opportunity Employer
It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or because he or she is a protected veteran.
It is also the policy of Humanato take affirmative action to employ and to advance in employment, all persons regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status, and to base all employment decisions only on valid job requirements.
This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.
Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion.
We also provide free language interpreter services.
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