LOCATION: Tampa or Remote
DEPARTMENT: Actuarial Services
REPORTING TO: VP, Actuary
Responsibility for all Medicaid actuarial work related to one or two of WellCare’s Medicaid state plans. Manage a team of analysts and/or 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 with state actuarial consultants. Candidate should have 2 years of Medicaid experience and SAS and/or SQL experience.
- Provide all actuarial support for one or two Medicaid states incluing forecasting, revenue accruals, risk sharing accruals, and ad hoc requests
- Negotiate Medicaid capitation rates/rate setting with state actuaries.
- Provide support for Medicaid market leadership – financial and operational
- Assist with development of any Medicaid state rate filings, including all managerial review and certification if necessary.
- Manage and perform monthly analysis identifying opportunities to reduce cost and utilization and provide recommendations to senior management.
- Manage and develop actionable recommendations to management relative to all analysis.
- Evaluate and assess the Medicaid contracts to determine areas of risk and opportunity.
- Lead, initiate, and develop key analysis to improve overall MLR results.
- Support and drive implementation of market initiatives to improve operating results.
- Develop and maintain relationships with and work closely with state consultanting actuaries 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 utilize this information in work products.
- Maintain necessary continuing education requirements as required by the Society of Actuaries.
- Additional projects as assigned.
- Advises management in short and long-range strategic planning for assigned Medicaid markets.
- Provides technical direction to associates, functional managers, other directors, and management.
- Recommends changes in area(s) policy and procedure.
- Direct participation with leadership 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.
- Required A Bachelor's Degree in a related field
- Preferred A Master's Degree in a related field
- 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.
Licenses and Certifications:
- 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.
A license in one of the following is required:
- Required Associate of the Society of Actuaries (ASA)
- Preferred Fellowship of the Society of Actuaries (FSA)
- 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