Actuary, Risk and Compliance

This is a fully remote position, open to applicants in United States.

📋 Description

• Oversee and manage actuaries and/or support personnel engaged in risk identification and management.

• Analyze potential risks and evaluate their possible financial impacts.

• Develop and propose controls and cost-effective strategies to reduce risks.

• Evaluate risks, opportunities, and mitigation strategies for compliant Medicare Advantage and Prescription Drug Plan bids.

• Ensure adherence to CMS requirements concerning Total Beneficiary Cost.

• Maintain Humana's internal version of the CMS Out-of-Pocket Cost Model.

• Gather necessary inputs from business partners.

• Execute and analyze the results from the Out-of-Pocket Cost Model.

• Collaborate with pricing actuaries to address test failures.

• Assist in MA-PD and PDP bid submissions by interpreting and applying CMS guidance.

• Establish and implement review standards and controls to reduce bid-filing compliance risks.

• Engage in CMS audits and reviews related to Medicare bids.

• Develop and sustain improvements in the bid-filing process.

• Evaluate and communicate actuarial and business risks throughout the organization.

• Offer peer review and advice on industry, company, and regulatory practices.

• Stay updated on advancements in actuarial methodologies.

• Investigate laws and regulations pertinent to actuarial science and insurance operations.

• Provide strategic advice to executives on significant functional matters.

• May potentially supervise one direct report.

⛳️ Requirements

• Bachelor's degree.

• A minimum of 8 years of technical experience.

• At least 2 years of experience in project leadership.

• Associate or Fellow in the Society of Actuaries (ASA or FSA).

• Member of the American Academy of Actuaries (MAAA).

• Proficiency in articulating ideas clearly in both written and verbal communication.

• Experience with Medicare Advantage is preferred.

• Capability to manage large projects involving both actuarial and non-actuarial personnel is preferred.

• Ability to work from a dedicated workspace without constant interruptions to safeguard member PHI/HIPAA information.

• Must have self-provided internet service with a minimum download speed of 25 Mbps and upload speed of 10 Mbps.

🏝️ Benefits

• Bonus incentive plan based on individual and/or company performance.

• Medical benefits.

• Dental benefits.

• Vision benefits.

• 401(k) retirement savings plan.

• Paid time off.

• Company holidays.

• Personal holidays.

• Paid parental leave.

• Paid caregiver leave.

• Short-term disability.

• Long-term disability.

• Life insurance.

• Wellness and smart healthcare decision support.

• Occasional travel to Humana offices for training or meetings.