Director, Actuarial Services

About CINQCARE

CINQCARE is an innovative health and care company on a mission to eliminate barriers and to improve care in high-need urban and rural communities. CINQCAREs purpose is to every day improve the health and well-being of those who need care the most in their homes and communities.

Overview

The Director Actuarial Services leads CINQCAREs actuarial function and is accountable for the integrity of the actuarial estimates financial analytics and performance reporting that drive enterprise decision-making. The role owns reserving and IBNR development pricing and underwriting of risk-based arrangements forecasting and budgeting and risk adjustment and affordability analytics across CINQCAREs Medicare Advantage Medicaid and ACO (REACH LEAD MSSP) portfolios.

Beyond producing analysis the Director sets the methodology assumptions and standards the function operates by builds the data and modeling infrastructure it depends on and translates technical results into clear recommendations for the Chief Financial Officer executive leadership the Board and investors. The Director also builds and develops the actuarial team including the Senior Actuarial Analyst(s) and partners closely with Finance Healthcare Economics Clinical Network and Operations.

This position reports to the Chief Financial Officer. The Director Actuarial Services should embody CINQCAREs core values including Trusted Empathetic Committed Humble Creative and Community-Minded. Additionally they should possess a commitment and deep conviction to CINQCAREs purpose & mission have healthcare experience with an understanding of value-based care and have familiarity with or worked in early-stage companies and be equipped to support scaling with the business. At CINQCARE we dont have patients or customers we have Family Members.

Responsibilities

• Actuarial Ownership and Financial Reporting

Own the actuarial function end to end across CINQCAREs Medicare Advantage Medicaid and ACO (REACH LEAD MSSP) portfolios including the methodology assumptions controls and documentation behind all actuarial estimates.

Own IBNR and reserve development; review and approve monthly reserve estimates set completion factor and trend assumptions and present reserve adequacy and roll-forward analysis to the CFO and external auditors.

Direct the actuarial contribution to monthly close and financial reporting including IBNR and P&L development medical expense analysis premium/revenue analysis and medical trend analysis.

Establish and defend key business assumptions with senior leadership to support monthly financial statements rolling forecast projections and annual budget development.

Proactively identify and quantify drivers of variance between actual and expected results across revenue utilization unit cost risk adjustment and quality and recommend corrective action.

Serve as the actuarial point of contact for external auditors actuarial consultants and partner actuarial teams and review work performed by third parties.

• Pricing Underwriting and Growth

Lead pricing and underwriting for new and renewing risk-based arrangements including rate development scenario and sensitivity testing and recommendations on acceptable risk positions.

Own pro forma analyses and multi-year projections supporting market entry new partnerships and expansion of the risk and MSO business portfolios.

Lead the actuarial evaluation of the transition from ACO REACH to the Long-term Enhanced ACO Design (LEAD) model including benchmark and capitation modeling risk track selection and multi-year financial impact.

Understand and interpret the financial terms of partner contracts quantify the economics of proposed terms and advise deal teams throughout negotiation and renewal.

Build and maintain contract performance monitoring so that settlement expectations risk corridors and shared savings estimates remain current well understood and aligned with financial reporting.

• Risk Adjustment Affordability and Performance Analytics

Direct risk adjustment analytics including RAF score monitoring HCC suspecting and recapture analysis and quantification of revenue impact and program return on investment.

Collaborate with business partners and corporate leadership to develop and manage a rigorous affordability agenda and risk revenue program both designed to improve performance of our risk and MSO business portfolios.

Oversee provider and network performance analytics including cost and utilization benchmarking attribution and evaluation of care model effectiveness in partnership with Clinical and Network teams.

Direct ad hoc and strategic analytics supporting executive leadership corporate strategy Board materials and investor diligence.

• Data Tools and Process

Establish the data foundation for actuarial work across claims encounter and enrollment data and Medicare Advantage (MMR MOR MA004) and ACO (BCDA CCLF) source files partnering with Data Engineering on data quality lineage and availability.

Set standards for actuarial models code and documentation including version control peer review and reproducibility of results.

Lead efforts to identify and develop process improvements including automation of recurring analytics and reporting that replaces manual processes with scalable auditable tooling.

Maintain a current view of CMS policy and value-based care trends across Medicare Advantage Medicaid and CMS ACO models and translate the implications into financial and strategic guidance.

• Leadership Communication and Culture

Build lead and professionally develop the actuarial team including the Senior Actuarial Analyst(s): set goals provide technical mentorship and review and support progress toward actuarial credentials.

Leadership: define and execute strategies and solutions to create business value in financial analytics including building a team to design develop and execute those strategies and solutions to deliver desired outcomes.

Provide timely comprehensive and clear communication of results to the CFO executive leadership and the Board translating technical analysis into decisions and recommended actions.

Knowledge: provide subject matter expertise in financial reporting and analysis solutions including determining and recommending approaches for financial analytics advancement solution deployment and performance evaluation.

Strategy: suggest new programs procedures and policies to continually improve efficiency and morale and to improve the employee experience.

Culture: accountable for creating a productive collaborative safe and inclusive work environment for the Actuarial Services team and as part of the larger Company.

Our Benefits

At CINQCARE we care for our team like we care for our patientsholistically. We offer flexible comprehensive benefits so you can thrive while delivering top-notch care.

• Medical Plans: Two comprehensive options offered to Team members.
• 401K: 4% employer match for your future.
• Dental & Vision: Flexible plans with in-network savings.
• Paid Time Off: Generous PTO holidays and wellness time.
• Extras: Pet insurance commuter benefits mileage reimbursement CME for providers and company-provided phones for field staff.

The working environment and physical requirements of the job include:

In-office work (minimum three days per week) is performed indoors in a traditional office setting with conditioned air artificial light and an open workspace.

In this position you will need an to communicate with customers vendors management and other co-workers in person and over devices sometimes with people who are agitated. Regular use of the telephone and e-mail for communication is essential. Sitting for extended periods is common. Must be able to receive ordinary information and to prepare or inspect documents. Lifting of up to 10 lbs. occasionally may be required. Good manual dexterity for the use of common office equipment such as computer terminals calculator copiers and FAX machines. Good reasoning ability is important. Able to understand and utilize management reports memos and other documents to conduct business.