Senior Director, Actuarial Science (Healthcare Policy - Medicaid, Medicare, Marketplace)

CareSource; Dayton (OH); On-site; USD 136,000 - 237,000; Full time

Job summary

CareSource is seeking a Senior Director, Actuarial Science to set strategic direction, drive innovation, and deliver key insights that will influence company performance across Medicaid, Medicare, and Marketplace programs.

You will lead a team of actuaries, ensure compliance with actuarial standards, develop models for pricing and forecasting, engage regulators and stakeholders, and translate industry trends into actionable business strategies.

Qualifications

• Bachelor's degree in actuarial science, mathematics, economics or a related field.
• Ten (10) years of decision support, financial analysis, or actuarial experience preferred
• Five (5) years of management experience preferred
• Strong database (SAS or Access) experience preferred
• Managed Care or healthcare experience preferred

Responsibilities

• Provide strategic leadership on healthcare policy and regulatory requirements.
• Lead actuarial pricing, forecasting, and performance monitoring activities.
• Develop internal statistical models to support business goals and pricing.
• Mentor analysts and ensure compliance with Actuarial Standards of Practice.
• Collaborate with regulators and internal stakeholders on policy and financial implications.

Skills

Actuarial leadership

Strategic direction

Forecasting

SQL

SAS

R

Communication

Education

Bachelor's degree in actuarial science or related field

Tools

SAS

SQL

R

Job description

Job Summary: The Senior Director, Actuarial Science is responsible for setting the strategic direction, driving innovation and producing key insights for the organization that drive company performance.

Essential Functions:

Provides strategic thought leadership on healthcare policy, maintaining expertise in Medicaid, Medicare, Marketplace, and evolving legislative and regulatory requirements; assesses emerging trends and translates their potential impact into actionable organizational strategies. Accountable for pricing, forecasting, month-end close activities and performance monitoring and explanations; includes development of key processes and assumptions, accruals and evaluation of financial experience and trend drivers including comparisons to budget and reforecast. Develop activities to improve efficiency and affordability. Lead a team of actuaries ensuring compliance with applicable Actuarial Standards of Practice and supporting their training and personal development. Develop the strategy and guide teams in the development of multiple internal statistical models to support key business goals / initiatives; bid pricing models, financial projections, contract modeling, ad hoc support projects. Ensure internal stakeholders are held accountable for actuarial function requests supporting key assumptions to be used throughout Finance and the broader organization. Proactively identify and influence at Senior Management levels Actuarial concepts / business drivers to support interactions with federal level and state level regulators. On request, lead new business projects for the business development team at the Senior Management level. Accountable for the integrity of all federal or state rate filing requirements as necessary. Identify and lead opportunities across multiple functions within the organization where the actuarial team can drive completion of corporate goals. Oversee effectiveness of mentorship programs for analysts. Remain current, be able to explain and understand business impacts of all pertinent industry developments, including but not limited to, federal and state regulations and sub-regulatory guidance. Recommends and operationalizes strategies that have direct impact on the achievement of functional strategies. Understand and explain the financial drivers for owned product/market, including IBNR and other accruals. Engage with federal and state trade associations, regulators, and other external stakeholders on policy and legislative matters, providing actuarial perspective to inform advocacy, regulatory interpretation, and business positioning Provide actuarial expertise to internal business, government affairs, compliance, legal, and other teams on proposed policy, legislation, regulations, and sub-regulatory guidance; support the development of organizational feedback, comments, and other responses that reflect financial, operational, and actuarial considerations Perform any other job related duties as requested.

Education and Experience:

• Bachelor's degree in actuarial science, mathematics, economics or a related field required
• Ten (10) years of decision support, financial analysis, or actuarial experience preferred
• Five (5) years of management experience preferred
• Strong database (SAS or Access) experience preferred
• Managed Care or healthcare experience preferred

Competencies, Knowledge and Skills:

• Excellent written and verbal communication skills
• Excellent listening and critical thinking skills
• Strong interpersonal skills and high level of professionalism
• Ability to manage, develop, and motivate staff
• Ability to interact with all levels of management as well as external stakeholders
• Excellent problem-solving skills and attention to detail
• Ability to effectively report data, analyze facts, and exercise sound business judgment when making recommendations
• Ability to identify and analyze problems, draw conclusions, develop and lead processes and communicate status and results
• Expert proficiency with Microsoft Suite to include Excel, Word, Power Point and Outlook
• Advanced knowledge of SQL, SAS, R, or other data manipulation software is preferred

Licensure and Certification:

• Associate of the Society of Actuaries (ASA) required
• Fellow of the Society of Actuaries (FSA) preferred

Working Conditions:

General office environment; may be required to sit or stand for extended periods of time. Up to 15% (occasional) travel based on the needs of the department may be required.

Compensation Range:

$135,600.00 - $237,400.00 CareSource takes into consideration a combination of 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 establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee’s total well-being and offer a substantial and comprehensive total rewards package. Compensation Type (hourly/salary): Salary

Organization Level Competencies

• Fostering a Collaborative Workplace Culture
• Cultivate Partnerships
• Develop Self and Others
• Drive Execution
• Influence Others
• Pursue Personal Excellence
• Understand the Business

This job description is not all inclusive. CareSource reserves the right to amend this job description at any time.

CareSource is an Equal Opportunity Employer.

We are dedicated to fostering an environment of belonging that welcomes and supports individuals of all backgrounds.

#LI-RW1 Brand=CareSource The CareSource mission is known as our heartbeat. Just as we support our members to be the best version of themselves, our employees are driven by our mission to create a better world for members, stakeholders and providers. We are difference-makers who combine compassionate hearts with our unique business expertise to make every opportunity count. Each claim, each phone call, each consumer-centric decision is a chance to change the world for one member, and our employees look for ways to do that every day. The challenge is, there is no one right way to be the difference and we’re looking for people like you that will rewrite that definition every day. We do what it takes to form creative solutions that make our community and the world just a little better. Discover what it means to be #UniquelyCareSource.