Director Actuarial Services, Geisinger Health Plan

Location:

Work from home (Pennsylvania)

Shift: Days (United States of America) Scheduled Weekly

Hours:

40 Worker Type:
Regular Exemption Status:
Yes

Job Summary:

This position is an analytics-focused leadership role within Actuarial Services. The role has direct leadership accountability for the Med Insight Payer Analytics platform and a designated portfolio of analytics functions within the Medical Economics scope. This portfolio may include one or more areas such as Employer Group Analytics, Underwriting Support, Value-Based Care (VBC) contracting, and utilization and unit cost analytics. Responsibilities include setting analytic direction and priorities, overseeing deliverables and staff, advancing analytics capabilities through innovation and continuous improvement, ensuring quality and consistency, and partnering with business leaders to translate data into actionable insights.

Qualifications for this role are centered on healthcare analytics, Medical Economics, and leadership experience rather than actuarial credentials.

Job Duties:

Qualifications for this role are centered on healthcare analytics, Medical Economics, and leadership experience rather than actuarial credentials. Develops and maintains Analytic standards necessary for interpreting financial recast models (Membership, Premium, Expense, and Medical Loss Ratio reporting) and utilization and expense trends. Reviews and provides approval of audits and performance analytic models utilized by executive management. Oversees the claim and premium deficiency reserves while working with auditors to arrive at mutually acceptable conclusions.

Oversees the pricing of products, including but not limited to, building sound pricing models and tools, working with internal staff to arrive at sound products and strategies, and working with regulatory authorities to get approval of products and pricing. Guides the forecasting, analytic, underwriting, and performance monitoring functions. This includes trend development, monitoring financial performance relative to budget/pricing, evaluating provider, vendor, and reinsurance agreements, and studying performance relative to external benchmarks.

Serves as subject matter expert for regulatory reform and legislative changes, while quantifying impact of change, and identifying potential risks to successful implementation. Supports strategic initiatives in the form of ideas, market research, financial modeling, business plan development, and implementation. Supports data management by providing direction and oversight to IT teams for appropriate data aggregation, partitioning, and extract rules to meet analytic and reporting needs.

Collaborates with departments to ensure accurate and timely operations. Provides guidance and support to upcoming actuarial talent. Work is typically performed in an office environment. Accountable for satisfying all job specific obligations and complying with all organization policies and procedures. The specific statements in this profile are not intended to be all-inclusive. They represent typical elements considered necessary to successfully perform the job.

Additional competencies outlined in any department-specific orientation will be considered essential to the performance of the job related to that position.

#LI-REMOTE

Education:

Bachelor's Degree- (Required)

Experience:

Minimum of 3 years-Managerial/Supervisory (Required), Minimum of 7 years-Health Insurance/Managed Care (Required)

Certification(s) and License(s):

Skills:

Office Administration

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