Sr Director Actuary Medicare

LOCATION: Tampa, FL or Remote

DEPARTMENT: Actuarial Svc

REPORTING TO: VP, Actuary

Responsibility for all Medicare actuarial work related to a portion of WellCare’s business. Manage a team of analysts and actuaries who provide timely, accurate, actionable data and analysis supporting the department, area, and corporate key initiatives. Participate as a key strategic member of Senior Management. Oversee the development of analytics for strategic and operating decisions to senior management. Provide proactive analysis and recommendations to senior management on both tactical and strategic nature. Develop and maintain relationships, and act as primary point of contact with external actuarial consultants.

Essential Functions:

  • Manage the monthly calculation of the Corporation’s IBNR reserves.
  • Assist with development annual Medicare filings and state rate filings, including all managerial review and certification if necessary.
  • Manage and develop actionable recommendations to management relative to all analysis.
  • Manage and perform monthly analysis identifying opportunities to reduce cost and utilization and provide recommendations to senior management.
  • Manage and supervise cross-functional teams to address key issues facing the organization.
  • Evaluate and assess the government reimbursement process to determine areas of risk and opportunity.
  • Oversee regional initiatives to improve operating results.
  • Lead, initiate, and develop key analysis to improve overall MLR results.
  • Develop and maintain relationships with and work closely with outside consultants and senior management to ensure that projects conform to Actuarial Standards of Practice.
  • Manage the monitoring of trends and changes in the actuarial field and healthcare industry and communicate findings to upper management and appropriate associates.
  • Maintain necessary continuing education requirements as required by the Society of Actuaries.
  • Additional projects as assigned.
Additional Responsibilities:
  • Advises senior management in long-range planning.
  • Provides technical direction to functional managers, other directors, and management.
  • Recommends changes in area(s) policy and procedure.
  • Direct participation with executive management regarding strategic assessment of projects and processes.
  • Recommendations to Chief Actuary in overall business strategy, project planning and corporate risk assessment.
  • Coordinate and participate in research-related activities including industry best-practices, research and development of models, tools, and data analysis projects, and experience studies.
  • Provide research and analysis to support, and participate in legislative initiatives involving WellCare, government entities, the managed care industry, the health insurance industry, actuarial organizations, the healthcare industry, and other fields as needed.
  • Ability to travel by automobile, plane or other public transportation as necessary.
Candidate Education:
  • Required A Bachelor's Degree in a related field
  • Preferred A Master's Degree in a related field
Candidate Experience:
  • Required 8 years of experience in significant health planning
  • Required 2 years of management experience
  • Preferred Other Experience presenting to and consulting with senior management on strategic decisions.
Candidate Skills:
  • Advanced Demonstrated leadership skills
  • Advanced Demonstrated interpersonal/verbal communication skills
  • Advanced Demonstrated written communication skills
  • Intermediate Ability to communicate and make recommendations to upper management
  • Advanced Demonstrated analytical skills
  • Intermediate Ability to work in a fast paced environment with changing priorities
  • Intermediate Demonstrated organizational skills
  • Intermediate Demonstrated problem solving skills Ability to define problems, collect data, establish facts, and draw valid conclusions
  • Intermediate Other Ability to interpret an extensive variety of technical instructions in mathematical or diagram form and deal with several abstract and concrete variables.
  • Intermediate Other Ability to remain calm under pressure.
Licenses and Certifications:
A license in one of the following is required:
  • Required Associate of the Society of Actuaries (ASA) Associ
  • Preferred Fellowship of the Society of Actuaries (FSA)
Technical Skills:
  • Required Intermediate Microsoft Word
  • Required Intermediate Microsoft Excel
  • Required Intermediate Microsoft Access
  • Required Intermediate Microsoft Outlook
  • Required Intermediate Other Knowledge of database reporting tools to assist in preparing analysis
Languages:

    About us
    Headquartered in Tampa, Fla., WellCare Health Plans, Inc. (NYSE: WCG) focuses primarily on providing government-sponsored managed care services to families, children, seniors and individuals with complex medical needs primarily through Medicaid, Medicare Advantage and Medicare Prescription Drug Plans, as well as individuals in the Health Insurance Marketplace. WellCare serves approximately 5.5 million members nationwide as of September 30, 2018. WellCare is a Fortune 500 company that employs nearly 12,000 associates across the country and was ranked a "World's Most Admired Company" in 2018 by Fortune magazine. For more information about WellCare, please visit the company's website at www.wellcare.com. EOE: All qualified applicants shall receive consideration for employment without regard to race, color, religion, creed, age, sex, pregnancy, veteran status, marital status, sexual orientation, gender identity or expression, national origin, ancestry, disability, genetic information, childbirth or related medical condition or other legally protected basis protected by applicable federal or state law except where a bona fide occupational qualification applies. Comprehensive Health Management, Inc. is an equal opportunity employer, M/F/D/V/SO.