Senior Actuary

Join Martins Point Health Care - an innovative not-for-profit health care organization offering care and coverage to the people of Maine and beyond. As a joined force ofpeople caring for people Martins Point employees are on amission to transform our health care system while creating a healthier community. Martins Point employees enjoy an organizational culture of trust and respect where our values - taking care of ourselves and others continuous learning helping each other and having fun - are brought to life every day. Join us and find out for yourself why Martins Point has been certified as a Great Place to Work since 2015.

Key Outcomes:

• Support the annual Medicare Advantage and Prescription Drug (MA/PD) bid development by working with the business and consulting actuarial firm on product design trend review and supplemental benefit projections that align with corporate objectives for growth and profit margin.
• Has lead responsibility for preparation and presentation of annual business healthcare expense budget and forecasting.
• Designs and implements measurement and monitoring of key performance metrics to identify trends and variances from budget and enable corrective actions on a timely basis.
• Provide analysis and advice to support the US Family Health Plan (USFHP) annual rate negotiation.
• Lead analysis and calculation of incurred but not reported claims (IBNR).
• Prepare and analyze monthly estimates for Medicare Part D settlement estimates.
• Develop and maintain knowledge and expertise in regional and national managed health care trends and best practices seeking opportunities to translate those to Martins Point.
• Manage the process for annual medical cost and utilization projections and forecasts by coordinating resources expertise and information in concert with the financial planning cycle.
• Provide expertise and consultation on a wide array of business functions including but not limited to provider reimbursement claims processing benefit adjudication and compliance
• Support senior management (Chiefs and VPs) with special projects and research including compiling white papers on special topics as needed.
• Collaborates with the business to ensure appropriate integration of workstreams and ultimate delivery on company strategies.
• Communicates and interacts effectively and professionally with co-workers management etc.

Education/Experience:

• Bachelors degree in actuarial science math statistics or a related field is required.
• 8 years of progressive actuarial experience in a wide range of medical expense analyses contracting in a managed care setting preferably in commercial and government programs business.
• Experience developing and managing a wide array of financial arrangements is preferred.

Required License(s) and/or Certification(s):

• Associate of the Society of Actuaries and Member of the American Academy of Actuaries.

Skills/Knowledge/Competencies (Behaviors):

• Demonstrates an understanding of and alignment with Martins Point Values.
• Strong analytical skills.
• Demonstrated interpersonal communications and team building skills.
• Strategic ability to see the big picture and connect dots across mathematical and financial relationships and across an organization.
• Proven ability to organize work simultaneously work on many activities and projects and meet deadlines directly and through matrix management.
• Strong track record of building internal and external collaborative relationships.
• Broad understanding of managed care business and financial principals such as underwriting medical management physician reimbursement and risk management.
• Strong oral and written communication to support executive level briefings and presentations both internal and external to Martins Point.

Exclusion from Federal Programs:

• Employee may not at any time have been or be excluded from participation in any federally funded program including Medicare and Medicaid. This is a condition of employment. Employee must immediately notify his/her manager or the Clinics Compliance Officer if he/she is threatened with exclusion or becomes excluded from any federally funded program.

This position is not eligible for immigration sponsorship.

We are an equal opportunity/affirmative action employer.

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