VP, Chief Medicaid Actuary

Job Summary

Vice President, Actuarial - Product is responsible for driving company strategy and managing actuarial expertise in coordination with other leaders on all aspects of Care Source’s rate levels to ensure actuarial soundness, and to use actuarial knowledge and tools to help improve profitability of Care Source’s lines of business.

• Drive company strategy and manage actuarial expertise in coordination with other leaders on all aspects of Care Source’s rate negotiations with the State Medicaid Departments, and to use actuarial knowledge and tools to help improve profitability of Care Source’s lines of business.
• Oversee and be responsible for all actuarial aspects of rate filing and bid development, including filing strategy, benefit strategy and design, filing compliance and manage external and internal actuarial resources and relationships involved with those functions.
• Evaluate and advise on the impact of long–range planning, introduction of new programs/strategies, and regulatory actions.
• Oversight of the actuarial forecast process; ensure the integrity of the data and methodology of the results and track changes and variances.
• Proactively research existing and new regulations/legislation and advise management of actions and potential risks.
• Provide strategic decision‑making support to market leadership on all aspects of the business including financial, clinical, operations, and product development.
• Oversee and assure the coordination, relevance and performance of all actuarial functions in support of Care Source business needs, and hold ultimate responsibility for necessary improvements and changes to keep pace with evolving business needs.
• Lead the selection and hiring of actuarial staff, and manage actuarial and other staff on a project basis for both actuarial and inter‑departmental projects.
• Manage continual improvement of actuarial processes and make changes as needed to support the business.
• Represent Actuarial Services and Care Source in written and verbal communications, presentations and meetings with regulators, owners and other outside parties regarding matters requiring actuarial expertise.
• Use analytical understanding to provide strategic insights and recommendations to Care Source’s C‑suite leadership in support of decisions related to the strategic direction of the company.
• Oversee and support the alignment of Actuarial Services with Finance Department to assure the best possible business intelligence and understanding of company financials in communications to Care Source executive leadership.
• Responsibility for decision making and strategy regarding actuarial inputs to the monthly financial reporting process and reports, such as claim reserves/accruals, variance analysis, actuarial contributions to Management Discussion & Analysis, etc.
• Implement and maintain actuarial processes and controls consistent with best practices to assure accurate and timely reporting and handoff of actuarial components and inputs to financial reporting.
• Perform any other job duties as requested.

• Bachelor of Science/Arts (BA/BS) degree in Actuarial Science, Mathematics or Finance.
• Minimum of ten (10) years of experience in the Actuarial Industry with a minimum of five (5) years of management experience.
• Minimum of seven (7) years of experience for the actuarial function in Healthcare, including Medicaid, Commercial and/or MA business, rate negotiations, design, state and federal reporting requirements, as well as other traditional actuarial functions.
• Managed care and state/federal government program experience preferred.
• Experience interacting with state or federal regulators, CMS or other external regulatory or auditing entities preferred.

• Excellent PC skills, including advanced Excel, Word and PowerPoint.
• Strong analytical skills.
• Strong problem solving and critical thinking skills.
• Ability to articulate and defend complex ideas and strategies to non‑technical audiences.
• Collaborative, with the ability to effectively influence others.
• Fact‑based decision maker.
• Experience with using a data warehouse.
• Excellent oral, written and…