VP, Chief Medicaid Actuary

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

📋 Description

• Lead the company's strategic initiatives and manage actuarial expertise in collaboration with other leaders on all aspects of CareSource’s rate negotiations with State Medicaid Departments.

• Utilize actuarial knowledge and tools to enhance the profitability of CareSource’s business lines.

• Oversee and take responsibility for all actuarial components of rate filings and bid development, including filing strategy, benefit design, compliance, and managing internal and external actuarial relationships.

• Assess and provide guidance on the implications of long-term planning, implementation of new programs/strategies, and regulatory changes.

• Supervise the actuarial forecasting process, ensuring data integrity and methodology, while monitoring changes and variances.

• Conduct proactive research on current and emerging regulations/legislation and advise management of potential risks and required actions.

• Offer strategic decision-making support to market leadership across all business facets including financial, clinical, operational, and product development areas.

• Ensure coordination, relevance, and effectiveness of all actuarial functions to meet CareSource's business requirements.

• Hold ultimate accountability for necessary enhancements and adaptations to keep pace with the evolving needs of the business.

• Lead the recruitment and selection of actuarial staff, managing both actuarial and other personnel on project basis for actuarial and inter-departmental initiatives.

• Drive continual improvement of actuarial processes and implement changes as necessary to support the organization.

• Represent Actuarial Services and CareSource in written and verbal communications, presentations, and meetings with regulators, stakeholders, and other external parties requiring actuarial expertise.

• Leverage analytical insights to provide strategic recommendations to CareSource’s C-suite leadership in support of the company’s strategic direction.

• Oversee and facilitate the alignment of Actuarial Services with the Finance Department to ensure optimal business intelligence and understanding of company financials communicated to CareSource executive leadership.

• Responsible for decision-making and the strategy concerning actuarial inputs to the monthly financial reporting process and reports, including claims reserves/accruals, variance analysis, and contributions to Management Discussion & Analysis.

• Implement and maintain actuarial processes and controls consistent with best practices to guarantee accurate and timely reporting and transfer of actuarial components and inputs to financial reporting.

• Perform additional job duties as needed.

⛳️ Requirements

• Bachelor of Science/Arts (BA/BS) degree in Actuarial Science, Mathematics, or Finance.

• A minimum of ten (10) years of experience in the Actuarial Industry with at least five (5) years in a management role is required.

• At least seven (7) years of experience in the actuarial function within Healthcare, including Medicaid, Commercial, and/or MA business, rate negotiations, design, state and federal reporting requirements, along with other traditional actuarial functions.

• Preferred experience in managed care and state/federal government programs.

• Experience interacting with state or federal regulators, CMS, or other external regulatory or auditing entities is preferred.

• Proficient in PC skills, including advanced proficiency in Excel, Word, and PowerPoint.

• Strong analytical capabilities.

• Exceptional problem-solving and critical thinking abilities.

• Capacity to articulate and defend complex concepts and strategies to non-technical audiences.

• Collaborative mindset with the ability to effectively influence others.

• Fact-based decision-maker.

• Experience utilizing a data warehouse.

• Excellent oral, written, and interpersonal communication skills.

• Strong managerial and team-building skills, with a proven history of hiring and cultivating high performers.

• A demonstrated track record of achievement and integrity.

• Licensure and Certification: Must be a Member of the American Academy of Actuaries (MAAA) and hold an Associate or Fellow designation from the Society of Actuaries (ASA or FSA).

• Must maintain memberships in the Society of Actuaries and the American Academy of Actuaries.

🏝️ Benefits

• CareSource considers a candidate’s education, training, and experience, as well as the position’s scope and complexity, the discretion and latitude required for the role, and other external and internal data when determining salary levels.

• In addition to base compensation, you may be eligible for a bonus linked to company and individual performance.

• We are deeply committed to every employee’s overall well-being and provide a substantial and comprehensive total rewards package.