AddressHealth Alliance Plan (HAP) is seeking a dynamic leader as the Director, Actuarial and Healthcare Analytics. As the Director, you will play a crucial role in shaping and overseeing HAP's Medicare financials analysis, medical expense budgeting, and coordination with consulting actuaries. This is a true leader who will own Medicare strategy, lead an exceptional team, and drive profitability and growth. This is an exceptional opportunity to leverage your expertise to make a significant impact on our organization's financial success and strategic direction.
Responsibilities:
- Financial Analysis and Modeling: Lead the development and enhancement of revenue and claim estimates, encompassing critical components such as risk scores and adjustments, trend analysis, drug rebates, reinsurance recoveries, and reserves. Utilize advanced modeling techniques to provide accurate and insightful financial projections.
- Team Development: Build and mentor a high-performing team capable of managing the bid process, valuation, financial analysis, forecasting, and monitoring of results. Foster a collaborative and growth-oriented environment, empowering team members to excel in their roles and contribute to overall organizational success.
- Medicare Advantage Plan Development: Develop a proficient team to manage all technical functions required in MAPD bid filing, including but not limited to CMS desk review, CMS bid audit, and compliance. Ensure adherence to regulatory guidelines and drive excellence in the bid filing process.
- Strategic Direction: Collaborate with senior leadership to define and execute the strategic direction of the Actuarial department. Provide valuable insights and recommendations based on data analysis and actuarial expertise, contributing to the achievement of HAP's long-term goals.
- Actuarial Consultation and Collaboration: Coordinate and collaborate with consulting actuaries for rate filings, year-end certifications, and bids. Leverage their expertise while actively participating in the development and refinement of actuarial methodologies and practices.
EDUCATION/EXPERIENCE REQUIRED:
- Bachelor's degree in a finance or quantitative discipline is required.
- Experience: Minimum of five (5) years of experience in Medicare Advantage and Drug plan bid filing or Commercial or Medicaid pricing and product development, utilizing actuarially sound methodologies. Demonstrated expertise in financial analysis and modeling, with a focus on Healthcare Analytics.
- Leadership: Proven track record of at least five (5) years of managerial experience, preferably leading and directing other leaders. Ability to inspire and motivate a diverse team, fostering a culture of continuous learning and professional growth.
- Technical Proficiency: Advanced proficiency in Excel, especially in model development. Strong analytical skills and attention to detail, with the ability to interpret complex data and communicate findings effectively.
CERTIFICATIONS/LICENSURESREQUIRED:
- Associate of the Society of Actuaries (ASA) required.
- Fellow of the Society of Actuaries (FSA) preferred.
Join our passionate and dedicated team at Health Alliance Plan and contribute to our mission of providing exceptional healthcare services to our members. We offer a competitive salary, comprehensive benefits package, and the opportunity to work in a collaborative and supportive environment.
Additional Details
This posting represents the major duties, responsibilities, and authorities of this job, and is not intended to be a complete list of all tasks and functions. It should be understood, therefore, that incumbents may be asked to perform job-related duties beyond those explicitly described above.
Overview
Under the leadership of President and CEO Robert G. Riney, Henry Ford Health is a
$6 billion integrated health system comprised of six hospitals, a health plan, and 250+ sites
including medical centers, walk-in and urgent care clinics, pharmacy, eye care facilities and
other healthcare retail. Established in 1915 by auto industry pioneer Henry Ford, the health system
now has 32,000 employees and remains home to the 1,900-member Henry Ford Medical Group, one
of the nation’s oldest physician groups. An additional 2,200 physicians are also affiliated with the
health system through the Henry Ford Physician Network. Henry Ford is also one of the region’s
major academic medical centers, receiving between $90-$100 million in annual research funding and
remaining Michigan’s fourth largest NIH-funded institution. Also an active participant in medical
education and training, the health system has trained nearly 40% of physicians currently practicing
in the state and also provides education and training for other health professionals including nurses,
pharmacists, radiology and respiratory technicians. visit HenryFord.com.
Benefits
Whether it's offering a new medical option, helping you make healthier lifestyle choices or
making the employee enrollment selection experience easier, it's all about choice. Henry
Ford Health has a new approach for its employee benefits program - My Choice
Rewards. My Choice Rewards is a program as diverse as the people it serves. There are
dozens of options for all of our employees including compensation, benefits, work/life balance
and learning - options that enhance your career and add value to your personal life. As an
employee you are provided access to Retirement Programs, an Employee Assistance Program
(Henry Ford Enhanced), Tuition Reimbursement, Paid Time Off, Employee Health and Wellness, and a whole host of other benefits and services. Employee's classified as contingent status are not eligible for benefits.
Equal Employment Opportunity/Affirmative Action Employer
Equal Employment Opportunity / Affirmative Action Employer Henry Ford Health is
committed to the hiring, advancement and fair treatment of all individuals without regard to
race, color, creed, religion, age, sex, national origin, disability, veteran status, size, height,
weight, marital status, family status, gender identity, sexual orientation, and genetic information,
or any other protected status in accordance with applicable federal and state laws.
