Senior Director, Financial Operations, Actuarial Strategy

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

📋 Description

• Take charge of the financial infrastructure, controls, and operational supervision for Emory Health Plan's medical, pharmacy, and administrative expenses.

• Develop and maintain financial operating systems, reporting schedules, budgeting processes, vendor financial oversight, and compliance frameworks.

• Manage vendor financial relations.

• Oversee the reconciliation of invoices from Third Party Administrators and Pharmacy Benefits Managers, ensuring payment accuracy and integrity.

• Supervise vendor financial performance, adherence to contracts, analysis of unit cost trends, and evaluation of administrative fee performance.

• Lead the review and interpretation of contracts from a financial perspective, identifying financial risks and aligning with budgetary assumptions.

• Assist senior leadership during negotiations with TPA, PBM, and stop-loss carrier contracts.

• Direct the regulatory compliance function and uphold compliance programs for relevant self-funded plan regulations.

• Manage regulatory submissions, state filings, audits, compliance documentation, and internal controls.

• Provide guidance to senior leadership on IBNR reserve management, claims lag analysis, and pharmacy rebate accounting.

• Create and maintain reporting and reconciliation processes for IBNR reserves in collaboration with external actuaries.

• Establish accounting methodologies for pharmacy rebate accruals, claims runout, and complex reserve items.

• Engage in annual rate-setting and pricing activities, offering financial inputs along with operational and claims analysis.

• Contribute financial insights for stop-loss reporting and benefits design financial modeling.

• Lead and nurture a team, including the hiring and management of additional personnel.

⛳️ Requirements

• A Bachelor's degree in accounting, finance, health administration, business administration, or a related field is required.

• A minimum of 9 years of progressive experience in health plan finance, managed care finance, or related healthcare financial operations.

• Proven expertise in financial controls, reporting, and accounting.

• CPA or an equivalent accounting credential is strongly preferred.

• A Master's degree in business administration, health administration, or a related field is preferred.

• Familiarity with self-funded plan regulations, including ERISA, HIPAA, ACA, Consolidated Appropriations Act transparency, and Mental Health Parity requirements.

• Experience in IBNR reserve management, claims lag analysis, pharmacy rebate accounting, financial controls, reporting, accounting, regulatory filings, audits, and vendor financial management.

• Capability to manage and develop a team, including hiring and directing additional staff, as well as providing performance management.

🏝️ Benefits

• Regular full-time employment.

• Remote work classification: Full Remote – Monthly.

• Occasional supported visits to an Emory University location.

• Equal opportunity employment.

• Reasonable accommodations for qualified individuals with disabilities.