Senior Staff Actuary - Medicare

EmblemHealth; New York (NY); On-site; USD 93,000 - 178,000; Full time

Job summary

EmblemHealth in New York seeks a Senior Actuary to lead pricing and reserve strategy, coordinate the actuarial staff, and manage rate filings with regulators. The role requires extensive actuarial expertise and leadership across lines of business.

The position emphasizes collaboration with product management and finance, oversight of premium rate filings, and strong analytical skills to drive product performance. A rigorous credentials path is required.

Qualifications

• Bachelor’s degree in Actuarial Science, Mathematics, or related field.
• ASA credential required.
• MAAA preferred.
• FSA preferred.
• Health insurance actuarial experience preferred.

Responsibilities

• Analyze financial performance of blocks of business with Senior Product Management and Finance.
• Identify opportunities to improve product performance across the organization.
• Oversee development and filing of premium rates with regulators (e.g., CMS, NY Department of Health).
• Collaborate with Risk Adjustment and other areas.
• Advise and develop reports for direct reports responsible for lines of business (e.g., ACA, Large Group, Medicare, Medicaid, SSP).
• Perform other duties as assigned or required.

Skills

Actuarial expertise

Leadership

Communication

Analytics

Education

Bachelor’s degree in Actuarial Science or related field

ASA credential required

MAAA preferred

FSA preferred

Tools

MS Office (Excel, Word, PowerPoint)

Data extraction & automation

Job description

• Provide the analytical resources necessary for the development of overall pricing and reserve setting strategies.
• Lead projects to analyze current rate structures and develop improvements and alternatives.
• Coordinate the actuarial staff as needed to support the activities of the affiliates.
• Lead actuarial staff as needed to support the activities of the affiliates.

Summary Of Position

• Provide the analytical resources necessary for the development of overall pricing and reserve setting strategies.
• Lead projects to analyze current rate structures and develop improvements and alternatives.
• Coordinate the actuarial staff as needed to support the activities of the affiliates.
• Lead actuarial staff as needed to support the activities of the affiliates.

Principal Accountabilities

• Work closely with Senior Product Management and Finance to analyze financial performance of blocks of business, including membership, trend, and financial analyses.
• Work collaboratively with all areas of the organization to identify opportunities to improve product performance.
• Oversee the development and filing of premium rates and/or expected costs with the appropriate regulatory authority (e.g., CMS, New York Department of Health).
• Work closely with Risk Adjustment and other areas.
• Advise and develop direct reports accountable for at least one line of business (e.g. ACA, Large Group, Medicare, Medicaid, SSP), as well as other staff.
• Perform other duties as assigned or required.

Qualifications

Education, Training, Licenses, Certifications

• Bachelor’s degree in Actuarial Science, Mathematics, other physical science, or related finance/business degree required
• Associate of the Society of Actuaries (A.S.A.) required
• Member of the American Academy of Actuaries (M.A.A.A.) preferred
• Fellow of the Society of Actuaries (F.S.A.) preferred

Relevant Work Experience, Knowledge, Skills, And Abilities

• 10+ years of relevant, professional work experience and/or education required
• 6+ years of actuarial experience with ASA; or 5+ years’ experience with an FSA required
• 5+ years health insurance actuarial experience, preferably in the managed care industry required
• 1+ year of management experience required
• Comprehensive understanding of actuarial principles and methodologies; strong mathematical and analytical skills required
• Knowledge of reimbursement methodologies required
• Ability to develop actionable reports for senior management required
• Excellent written and oral communication skills to deliver complex information required
• Proficiency with MS Office (Word, Excel, Access, PowerPoint, Outlook); data extraction, simulations, automation required

Additional Information

• Requisition ID: 1000003335
• Hiring Range: $92,880-$178,200