Actuarial Services Manager - Corporate

CareOregon, Inc.; United States; Remote; USD 170,000 - 208,000; Full time

Benefits offered by this job

Total Rewards Program

Bonus opportunity

Job summary

CareOregon is seeking an Actuarial Services Manager - Corporate to lead actuarial work for financial reporting, including IBNR estimates, reserves, and cost analyses. You will forecast healthcare utilization, support budgeting, and ensure CMS and OHA regulatory reporting is completed accurately.

This role combines technical management with people leadership, shaping strategic plans and delivering actionable insights to senior leaders across the organization.

Qualifications

• Minimum 5 years’ experience in actuarial services related to health care.
• Experience with health insurance actuarial work and regulatory reporting.
• Strong leadership and communication skills.

Responsibilities

• Lead development and communication of actuarial analyses for financial reporting.
• Manage models for IBNR and PDR liabilities and other assets/liabilities.
• Forecast cost and utilization trends and support budgeting.
• Oversee regulatory reporting for CMS and OHA.
• Develop ROI evaluation tools and drive data-driven decisions.

Skills

SAS

SQL

R

Excel

Leadership

Tableau

Education

Associate of the Society of Actuaries

Fellow of the Society of Actuaries

Tools

Tableau

Job description

Actuarial Services Manager - Corporate

This position is responsible for managing the actuarial components of financial reporting and analysis cycles within the organization. This includes providing actuarial estimates of Incurred But Not Reported (IBNR) liabilities and other assets and liabilities, analyzing trends, identifying deviations from benchmarks and the resulting financial impacts, forecasting changes in health care cost and utilization patterns, estimating and calculating the return on investment of proposed and implemented initiatives, completing required regulatory reporting, and communicating results and findings from actuarial analyses within CareOregon. Primary duties include technical and operational management, as well as relationship and people management. This position provides input into strategic plans for the broader organization.

Estimated Hiring Range:

$170,460.00 - $208,340.00

Bonus Target:

Bonus - SIP Target, 5% Annual

Essential Responsibilities

Technical/Operational Management

• Work with the Director, Actuarial Services to manage the development and communication of actuarial analysis related to financial reporting in alignment with organizational vision and goals.
• Develop and maintain models to determine actuarial estimates of IBNR, Premium Deficiency Reserve (PDR) liabilities, and other assets and liabilities; manage regular processes to ensure financial reporting deadlines are met.
• Develop and maintain actuarial cost models to perform cost and utilization analysis; identify and explain key drivers of historical trends; gather and develop benchmarks for purposes of assessing performance and the potential for improvement.
• Lead trend forecasting for use in budgeting; work with Financial Planning & Analysis team to set budgeted utilization and cost targets and evaluate actual results against budget.
• Analyze financial performance and work with LOB Finance team to communicate results and drivers of historical and forecasted performance to business leaders; identify opportunities to influence current and future outcomes.
• Create models of proposed interventions for use in goal setting, budgeting, and forecasting.
• Oversee the design, development, and implementation of evaluation tools to measure the effectiveness and ROI of various programs.
• Drive strategic use of data to support business efficiencies and competitive decision‑making.
• Ensure the timely completion of assigned regulatory reporting for CMS and OHA.

Relationship Management

• Communicate effectively, encouraging and creating a collaborative culture within Strategic Finance and cross-functionally.
• Build and ensure effective relationships across internal teams and external organizations for current or future integration.
• Partner with internal leaders and managers in identifying improvement plans and processes.

Employee Supervision

• Manage team(s) and recommends team direction and goals in alignment with the organizational mission, vision, and values.
• Identify work and staffing needs to meet work expectations; recruit and hire, using an equity, diversity, and inclusion lens.
• Plan, organize, schedule, and monitor work; ensure employees have information and resources to meet job expectations.
• Participate in 1:1, team, and department meetings; attend all staff meetings.
• Lead the development, communication, and oversight of team and individual goals; ensure goals, expectations, and standards are clearly understood by staff.
• Train, supervise, motivate, and coach employees; provide support toward employee development.
• Incorporate guidance from CareOregon equity tools into people leadership, planning, operations, evaluation, and decision making.
• Ensure team adheres to department and organizational standards, policies, and procedures.
• Evaluate employee performance and provide regular feedback to support success; recognize strong performance and address performance gaps and accountability (corrective action).
• Perform supervisory tasks in collaboration with Human Resources as needed.

Experience and/or Education

Required

• Minimum 5 years’ experience in actuarial services related to health care
• Work experience in health insurance
• Associate of the Society of Actuaries

Preferred

• Minimum 2 years’ experience in a supervisory position or minimum 1 year experience in a supervisory position with completion of CareOregon’s Aspiring Leaders Program
• Fellow of the Society of Actuaries
• Experience with Medicaid and Medicare
• Experience estimating IBNR, risk adjustment transfers, and other health care liabilities and assets
• Experience analyzing health care cost and utilization data

Knowledge, Skills and Abilities Required

Knowledge

• Extensive knowledge of managed care and the Oregon Health Plan
• Knowledge of various methods of estimating IBNR and other reserves
• Ability to construct and use actuarial cost models for performing cost and utilization, trend, and benchmarking analysis
• Understanding of how to model direct and indirect financial impacts in a complex system
• Strong understanding of data systems and relational databases

Skills and Abilities

• Proficient with SAS, SQL, and/or R
• Advanced Excel skills
• Excellent critical thinking and problem-solving skills
• Effective leadership skills and advanced understanding of managerial concepts and techniques in areas such as work planning, training delegating, coaching, mentoring, and evaluating staff
• Ability to develop and assess actuarial analyses and models pertaining to managed care
• Ability to communicate effectively, both verbally and in writing, including strong presentation skills
• Ability to develop and lead high performing team members, including hiring, goal setting, coaching, performance management, and career development
• Ability to develop and maintain Tableau dashboards
• Ability to work with eligibility data, claims data, risk scores, and other financial data
• Ability to work in an environment with matrix reporting, diverse individuals, and groups
• Ability to identify, implement, and manage process improvements
• Ability to work effectively with diverse individuals and groups
• Ability to learn, focus, understand, and evaluate information and determine appropriate actions
• Ability to accept direction and feedback, as well as tolerate and manage stress
• Ability to see, read, hear, speak clearly, and perform repetitive finger and wrist movement for at least 6 hours/day

Working Conditions

Work Environment(s): Indoor/Office Community Facilities/Security Outdoor Exposure

Member/Patient Facing: No Telephonic In Person

Hazards: May include, but not limited to, physical and ergonomic hazards.

Equipment: General office equipment

Travel: May include occasional required or optional travel outside of the workplace; the employee’s personal vehicle, local transit or other means of transportation may be used.

Work Location: Work from home

We offer a strong Total Rewards Program. This includes competitive pay, bonus opportunity, and a comprehensive benefits package. Eligibility for bonuses and benefits is dependent on factors such as the position type and the number of scheduled weekly hours. Benefits-eligible employees qualify for benefits beginning on the first of the month on or after their start date. CareOregon offers medical, dental, vision, life, AD&D, and disability insurance, as well as health savings account, flexible spending account(s), lifestyle spending account, employee assistance program, wellness program, discounts, and multiple supplemental benefits (e.g., voluntary life, critical illness, accident, hospital indemnity, identity theft protection, pre-tax parking, pet insurance, 529 College Savings, etc.). We also offer a strong retirement plan with employer contributions. Benefits-eligible employees accrue PTO and Paid State Sick Time based on hours worked/scheduled hours and the primary work state. Employees may also receive paid holidays, volunteer time, jury duty, bereavement leave, and more, depending on eligibility. Non-benefits eligible employees can enjoy 401(k) contributions, Paid State Sick Time, wellness and employee assistance program benefits, and other perks.

We are an equal opportunity employer

CareOregon is an equal opportunity employer. The organization selects the best individual for the job based upon job related qualifications, regardless of race, color, religion, sexual orientation, national origin, gender, gender identity, gender expression, genetic information, age, veteran status, ancestry, marital status or disability. The organization will make a reasonable accommodation to known physical or mental limitations of a qualified applicant or employee with a disability unless the accommodation will impose an undue hardship on the operation of our organization.