Summary:

Oversee the development of pricing recommendations for all Commercial Business. Coordinate with UW including enhancement of UW Pricing Tools. Analytical/Actuarial support for Pharmacy business. Work closely with P&L Leadership, Sales, UW, Finance, and Product to develop pricing strategies to deliver on Financial Plan membership and margin commitments. Coordinate the actuarial staff as needed to support the activities of the affiliates.

Accountabilities:

Work closely with Senior Product Management and Finance to analyze financial performance of blocks of business, including membership, trend, and financial analyses.  Work collaboratively with all areas of the organization to identify opportunities to improve product performance. Lead analytical support and product/strategy evaluation of pharmacy experience and product designs. Oversee development and filing of premium rates for all products with the appropriate regulatory authority (e.g.,CMS, New York Dep’t of Health). Manage financial forecast for Commercial lines of business and evaluate emerging experience to identify variance drivers and potential action plans. Develop and grow business partner relationships and provide consultative support and insights to help influence the direction of the business. Manage and develop a high‐performing Actuarial team; build succession plans. Supervise and develop direct reports accountable for Medicare and State Sponsored areas, as well as other staff. Work closely with Risk Adjustment and other areas to optimize risk adjustment and related programs to increase EmblemHealth’s premium revenue for these segments.

Requirements:

Bachelor’s degree in Actuarial Science, Mathematics, other physical science, or related finance/business degree required Associate of the Society of Actuaries (ASA) required Fellow of the Society of Actuaries (F.S.A.) preferred 12+ years of relevant, professional work experience and/or education required 10+ years of actuarial experience with ASA; or 8 + years’ experience with an FSA required 5+ year of management experience, preferably in the managed care industry required Comprehensive understanding of actuarial principles and methodologies with strong mathematical and analytical skills required Excellent written and oral communication skills to deliver complex information and achieve positive results required Capable with Excel, data extraction, simulations, automation required Proficiency with MS Office (Word, Excel, Access, PowerPoint, Outlook) required Knowledge of data querying skills using tools such as SQL or SAS Enterprise Guide required Knowledge of reimbursement methodologies required Additional Information Job Type: Standard Schedule: Full-time Employee Status: Regular Requisition ID: 1000002044 Hiring Range: $150,000-$280,000