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Actuarial Pricing Manager
Exempt or Non-ExemptExempt
The Pricing Strategy & Analytics Manager will oversee various activities supporting HMSA's pricing and financial forecasting activities; including monitoring of emerging experience, trend analysis and projections, developing financial forecasts and budgets and providing general product development and pricing support. He/she will also serve as a subject matter expert and internal consultant for various other risk adjustment and payment activities. The Pricing Strategy & Analytics Manager will be responsible for recruitment, as necessary, mentorship, training, and development of staff employees in the Pricing Analytics unit.
- Bachelor's degree and 5 years of related work experience; or equivalent combination of education and related work experience.
- Example of 5 Years of relevant work experience:
- FSA, MAAA, and 3+ Years of relevant work experience
- ASA, MAAA, and 4+ Years of relevant work experience
- 2 years of supervisory/management experience.
- Strong analytical skills
- Ability to read, analyze and interpret financial reports and complex statistical data
- Effective communication skills
- Demonstrated ability to work independently
- Working knowledge of the health insurance industry
- Good working knowledge of Microsoft Office applications
- Strong Microsoft Excel skills
Duties and Responsibilities
- analyze historical trends and identify trend drivers by service category and trend component;
- inventory provider contract changes, model aggregate impact of these on unit cost trend and calculate impact on historical and future expenses;
- enhance HMSA's prospective trend projection model; and develop prospective healthcare expense trends for forecasting and pricing purposes.
- monitor emerging experience by geography, network, provider, product, line of business, population or account;
- analyze drivers of financial performance; and develop & implement strategies to achieve financial sustainability or targets.
- review administrative and non-claims expense allocations and projections;
- estimate cost impact of new benefits or products or changes to existing benefits or products; and generate and analyze data supporting rating factor development.
- propose and implement enhancements to HMSA's financial forecasting models;
- develop and review revenue projections by renewal month, calendar month and product or line of business;
- develop and review expense projections by calendar month and product or line of business; consolidate revenue and expense projections into HMSA's financial budget.
- ACA & Medicare risk adjustment calculations;
- payment transformation base payment rates & bonus structure;
- pay for quality or advanced hospital care programs. This function to include reviewing HMSA's calculation & payment methodologies as well as evaluating the potential financial impact of alternative methodologies or procedures and reasonability checking of modeled results
- recruit, as necessary, train and develop appropriate support staff to maximize productivity and meet the department and organizational business objectives;
- provide performance standards feedback and coaching to staff including interim and year-end performance reviews; and develop the unit business plan and budget and oversee accurate allocation of unit and departmental costs based on program reporting requirements.