Job Description

POSITION SUMMARY/RESPONSIBILITIES

This position is responsible for driving and supporting company strategy and managing actuarial expertise in coordination with others to ensure actuarial soundness, and to use actuarial knowledge and tools to help improve profitability of Community First Health Plans, Inc. (Community First) lines of business. Monitors claims trends and investigates aberrations, tracks member risk scores to support risk adjustment analysis, and on-going analysis and monitoring of utilization trends. Assist in actuarial filings such as the Statement of Actuarial Opinion, ACA Marketplace rate filing and the annual Medicare bid. Coordinate between external consultants and internal staff on annual Medicare Advantage rate filings and assess the Texas Health & Human Services Commission’s (HHSC) development of the annual Medicaid rates. Support the annual budget process and reviews work papers of other Finance staff as needed. Provide ad hoc reporting assistance to executive level management as needed.

EDUCATION/EXPERIENCE

Bachelor’s degree in Actuarial Science, Mathematics, or Finance. A minimum of five (5) years of experience in the Actuarial Industry is required. A minimum of five (5) 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. Minimum of five (3) years of management experience is preferred. 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. Proficiency to Expert knowledge in Excel and computer coding (SQL/SAS) experience is required. Strong analytical skills and experience with medical claims trends, reserving, forecasting, and pricing. Ability to communicate complex analytical results effectively. Ability to provide guidance and support to entry level analyst staff. Associate of the Society of Actuaries (ASA) and Membership in the American Academy of Actuaries (MAAA) preferred. University Health

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