Vice President, Actuarial Services & Risk Management (Medicare)

Location: Woodland Hills, CA
Position Purpose: Provide expertise and actuarial support to ensure efficient and effective operations of the commercial product lines.
  • Develop actuarial pricing models for commercial and Exchange products to calculate the required premium levels in the open enrollment environment.
  • Deliver pricing models that reflect the impact of ACA structural rating rules and develop various scenarios to identify pricing variations and risk margin
  • Provide analytical support to improve long-term stability and financial viability of Exchange products through risk adjustment modeling to optimize revenue
  • Establish assumptions and provide feedback on product design and reimbursement strategies
  • Provide actuarial expertise and support business expansion activities for new product lines
  • Provide pricing for renewal business, new benefit design for marketplace and continue to price renewals for adequate rate increase
  • Provide support for reinsurance arrangement and establish and adjust premium deficiency reserve and various capital requirements
  • Work closely with Exchange and DOI authorities to negotiate adequate pricing and to gain required approvals

Education/Experience: Bachelor’s degree in Finance, Business Administration, Actuarial Science or related field. 10+ years of actuarial experience. Knowledge of Health Care Reform (ACA) regulations and implications on actuarial services and risk management. Previous management experience including responsibilities for hiring, training, assigning work and managing performance of staff. 

License/Certification: Associate or Fellow of the Society of Actuaries (ASA or FSA).

April A. Estes
Senior Recruiter
720-439-2609 Direct
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