Sr. Staff Actuary (Medicare)

EmblemHealth; New York (NY); On-site; USD 90,000 - 150,000; Full time

Job summary

An established industry player is seeking a seasoned actuary to lead innovative pricing strategies and enhance product performance. This role involves collaborating across departments to analyze financial performance and develop actionable reports for senior management. The ideal candidate will bring over a decade of actuarial experience, particularly in health insurance, and possess strong analytical and leadership skills. Join a dynamic team dedicated to improving healthcare access and quality while fostering a culture of diversity and inclusion. This is a fantastic opportunity to make a significant impact in a forward-thinking organization.

Benefits

Competitive health benefits

Welfare benefits

Retirement benefits

Incentive pay plans

Qualifications

• 10+ years of relevant experience in actuarial science or related fields.
• Strong mathematical and analytical skills are essential.

Responsibilities

• Lead projects to analyze and improve pricing and reserve strategies.
• Coordinate actuarial staff to support affiliate activities.

Skills

Analytical Skills

Mathematical Skills

Communication Skills

Leadership

Education

Bachelor’s degree in Actuarial Science or related field

Associate of the Society of Actuaries (A.S.A.)

Member of the American Academy of Actuaries (M.A.A.A.)

Fellow of the Society of Actuaries (F.S.A.)

Tools

MS Office

Job description

For the last 80 years, EmblemHealth has been taking care of New York’s heart and soul, its people. Today, health care is more complex than ever. That’s why we’re at the forefront of change. We work alongside our customers to offer access to high-quality, affordable care, help navigate the health care experience, and make good health achievable; because everyone deserves to be taken care of. We deliver on our mission every day by living our values with our colleagues, members, clients and partners. It begins with caring and respecting all those we work with. We believe a culture of diversity and inclusion is vital to serve our unique and diverse customers. We seek for continuous improvement and innovation and believe being agile and nimble is our advantage. We bring a strong sense of partnership to every relationship – internally and externally. The EmblemHealth family of companies offers competitive health, welfare, and retirement benefits as well as incentive pay plans and more.

Responsibilities:

• 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.
• 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.

Requirements:

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