Manage actuarial expertise to support the Medicare LOB in Shared Services and Kaiser Permanente Regions. This position plays a vital role in support of actuarial methods and resources that fit combined needs of each region and Program to support their business objectives. Department goals include: CMS (Center for Medicare and Medicaid Services) bid submissions that are compliant with regulatory guidance. Medicare products that meet KP goals for affordability and market demands and opportunities. Product pricing that supports KP mission, and yields sustainable margins in aggregate that support KP’s charitable mission. Product design and bid submission considerations that support KP receiving the full revenue that they are entitled to receive. Cross functional coordination and integration among all the regions. Control systems that support the needs of management and the business.
Essential Responsibilities:
Oversee the development of Medicare bids across KP accounting for $30 billion in revenue and providing healthcare for 1.6 million Medicare members
Promote the professional development of actuarial and data analytic staff supporting the Medicare LOB.
Provide analytics to forecast CMS revenue for Medicare Advantage products
Develop competitive benchmarks on utilization and costs that support strategic decisions for Medicare LOB
Oversee the development of pricing models for Group Medicare Premium rating, including disruption analytics on a group-specific basis for changes to model
Provide feedback to CMS on elements of Medicare bid requirements and the MA-PD bid process that KP recommends be changed
Conduct analytics to inform understanding of market cost shift in the market provider contracts on pricing decisions and margin expectations
Provide training to actuarial staff and Medicare community
Provide strategic advice to:
Regional leadership regarding underwriting, pricing, marketing, finance, benefit and product design.
Financial leadership by conducting actuarial studies, developing recommended actions and presenting them to executives to improve plan performance.
Utilize actuarial principles to assist in special studies such as expansion strategy, mergers and acquisitions, marketing strategies and improvement.
This position has a target base salary of $234,000 to $292,500 and is eligible for incentive compensation, comprehensive health, wellness, time off, savings, and retirement benefits, as well as relocation support, as applicable.
Basic Qualifications:Experience
Minimum ten (10) years experience in various health plan, insurance and actuarial required.
Minimum five (5) years management experience involving insurance or actuarial functions.
Education
Bachelor’s degree in math, actuarial science, business, finance, economics or related discipline is expected.
License, Certification, Registration
Member of the American Academy of Actuaries Certificate
Associate of the Society of Actuaries Certificate
Additional Requirements:
The Executive Director, Actuarial Services, must have strong expertise in actuarial methods and insurance, strong strategic and external focus and excellent negotiation skills.
The successful candidate must have experience that includes the following:
Extensive experience in Medicare and the CMS Medicare Advantage bid submission requirements
Extensive experience in health insurance leadership positions is required.
Demonstrated ability to negotiate “win-win” situations as it relates to business decisions.
The ability to build partnerships and influence other leaders is critical.
Experience in the health care field or the managed care environment is required.
Excellent analytical and influencing skills. Demonstrated ability to build effective partnerships and act as a thought partner with the leadership team. High energy, persistence and initiative to act are essential.
Preferred Qualifications:
Fellowship in the Society of Actuaries is preferred.