Actuarial Services Manager - Medicaid And Medicare

Candidates hired for remote positions must reside in Oregon, Washington, Utah, Idaho, Arizona, Nevada, Texas, Montana, or Wisconsin.

Job Summary

This position is responsible for managing actuarial analysis related to Medicaid and Medicare Advantage lines of business with a focus on supporting strategic decision making throughout the organization. This includes analyzing Medicaid capitation rates, overseeing the actuarial components of the Medicare Advantage bid pricing, and analyzing historical and emerging experience to identify opportunities to improve financial outcomes for CareOregon, its provider network, and its members. 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.

Essential Responsibilities

Technical/Operational Management

• Work with the Director, Actuarial Services to execute plans and goals for actuarial analysis of the financial performance of Medicaid and Medicare lines of business in alignment with organizational vision and goals.
• Collaborate with internal leaders to understand drivers of historical financial performance and lever to impact future financial performance.
• Act as a subject matter expert on Medicaid and Medicare lines of business including, but not limited to, regulatory requirements, industry trends, competitive analysis, and drivers of revenues and expenses.
• Provide Medicaid rate setting support through data analysis, policy review and strategy development; identify any actuarial unsound adjustments to the rates; advise internal leadership on strategies to impact rates.
• Oversee and coordinate external actuarial consultant’s work preparing the annual Medicare Advantage bid; advise internal leadership on potential bid pricing strategies.
• Collaborate with Risk Adjustment team to monitor risk adjustment applied to capitation revenue and lead effort to ensure population risk is appropriately represented in encounter data.
• Drive strategic use of data to support business efficiencies and competitive decision-making.
• Effectively articulate and disseminate financial projections and analyses using a variety of communication channels to include written reports, graphic data display, PowerPoint presentations, speaking engagements, and manuscript publications.
• Collaborate with Accounting and other teams to ensure the timely completion of regulatory reporting.

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 recommend 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 provides regular feedback to support success; recognizes strong performance and address performance gaps and accountability (corrective action).
• Perform supervisory tasks in collaboration with Human Resources as needed.

Organizational Responsibilities

• Perform work in alignment with the organization’s mission, vision and values.
• Support the organization’s commitment to equity, diversity and inclusion by fostering a culture of open mindedness, cultural awareness, compassion and respect for all individuals.
• Strive to meet annual business goals in support of the organization’s strategic goals.
• Adhere to the organization’s policies, procedures and other relevant compliance needs.
• Perform other duties as needed.

Experience and/or Education

Required

• Minimum 5 years’ experience in Actuarial Services related to health care
• Work experience in health insurance
• Experience with Medicaid or Medicare Advantage
• 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 the Medicare Advantage bid process

Knowledge, Skills and Abilities Required

Knowledge

• Extensive knowledge of managed care and the Oregon Health Plan
• Ability to analyze financial performance of a line of business, identify key drivers of results, and recommend actions to impact future results
• Understanding of Medicaid rate setting processes
• Knowledge of Medicare Advantage bid process
• Understanding of various risk adjustment methodologies (e.g. CDPS+Rx, CMS-HCC, ACG, ERG, MARA)
• 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 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.

#Li-Remote

Candidates of color are strongly encouraged to apply. CareOregon is committed to building a linguistically and culturally diverse and inclusive work environment.

Veterans are strongly encouraged to apply.

We are an equal opportunity employer. CareOregon considers all candidates regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, genetic information, disability, or veteran status.

Visa sponsorship is not available at this time.