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Actuarial Pricing Manager

at HMSA

Posted: 10/2/2019
Job Reference #: 5000445378506
Keywords:

Job Description

Employment Type

Full-time

Exempt or Non-Exempt

Exempt

Job Summary

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.

Minimum Qualifications

  • 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

1. Oversee medical & prescription drug trend analysis to support financial forecasting and pricing activities; including:
  • 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.
2. Direct and perform data mining, statistical and business analysis of healthcare experience, including:
  • 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.
3. Provide general product development and pricing analysis and support, including:
  • 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.
4. Provide oversight and support for HMSA's financial forecasting and budgeting activities, including:
  • 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.
5. Serve as a subject matter expert and internal consultant for the following programs/activities:
  • 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
6. Manage the Pricing Analytics unit:
  • 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.
7. Contribute to or lead special projects, or other duties as assigned