VP-Chief Actuary-Presbyterian Health Plan

VP Chief Actuary

Location Address: 9521 San Mateo NE Albuquerque, NM

Key Responsibilities:

Product and Pricing Strategy

A. Evaluate and Promote Medicaid Rate Adequacy & State Partnership

• Oversee evaluation of capitation rate assumptions.

• Partner directly with the state Medicaid agency to ensure assumptions are reasonable, risk is managed, and rates are actuarially sound.

• Support rate negotiations and data submissions to the state and CMS.

• Analyze the impact of risk adjustment models, acuity shifts, redeterminations and eligibility churn, directed payments and supplemental payment programs, changes in covered benefits, eligible population, and provider payment schedule changes.

B. Ensure Commercial and Medicare rates balance competitiveness and adequacy, and comply with applicable regulatory standards

• Set premium rates for individual, small group, large group, and government programs (e.g., Medicare Advantage, Affordable Care Act marketplace plans).

• Oversee trend analysis (medical cost inflation, utilization changes, provider contracting impacts).

• Approve final rate filings submitted to state and federal regulators.

C. Product Development, Underwriting and pricing

• Partner with product, underwriting, and finance teams to support new product design and market expansion.

• Supervise the underwriting team

• Maintains and updates pricing models to evaluate rating impact of regulatory changes and benefit plan changes

Financial Oversight & Forecasting

• Oversee actuarial balance sheet items:

o Claims liability reserves (IBNR) estimation

o Provider incentive payments or receivables

o Premium deficiency reserves

o Risk corridor payables/receivables

o Risk adjustment revenue projections

• Partner with finance team on forecasting

• Lead actuarial analytics teams.

• Analyze and explain drivers of rolling trends in claims experience, provider contract performance, pharmacy costs, and population health metrics

Regulatory & Statutory Accountability

• Sign statutory actuarial opinions.

• Interface with:

o State Department of Insurance

o State Medicaid agency

o Centers for Medicare & Medicaid Services

• Oversee compliance with Medicaid managed care rate certification standards.

• Ensure adherence to minimum MLR requirements.

• Certify compliance with mental health parity quantitative treatment limits

(Oversee commercial product risk adjustment submissions and validation)

Governance & Talent Leadership

• Maintain actuarial standards (e.g., compliance with the Actuarial Standards of Practice).

• Recruit and develop actuarial leadership.

• Maintain relationships with external auditors and consulting actuaries.

Additional Job Description

Qualifications

• BA or BS in actuarial science, math, or og

• Fellow of the Society of Actuaries (FSA) or Associate of the Society of Actuaries (ASA) required;
Member of the American Academy of Actuaries (MAAA) required.

• 10+ years of actuarial experience in health insurance, with significant leadership responsibility.

• Extensive knowledge of and experience in Medicaid

• General knowledge and experience in Medicare Advantage, ACA, and/or commercial health markets

• Expertise in pricing, reserving, forecasting, and regulatory filings.

• Strong executive communication skills and ability to influence senior leadership.

• Proven ability to lead teams and manage complex, multi stakeholder initiatives.

Preferred Attributes

• Experience in value based care, risk adjustment, and population health analytics.

• Background in enterprise risk management or capital strategy.

• Ability to translate complex actuarial concepts into actionable business insights.

• Strategic thinker with a bias for collaboration and innovation.

• Demonstrated ability to develop practical solutions and drive outcomes

Benefits Benefits are effective day-one (for .45 FTE and above) and include:

• Competitive salaries
• Full medical, dental and vision insurance
• Flexible spending accounts (FSAs)
• Free wellness programs
• Paid time off (PTO)
• Retirement plans, including matching employer contributions
• Continuing education and career development opportunities
• Life insurance and short/long term disability programs

About Us Presbyterian Healthcare Services…