Boston Medical Center HealthNet Plan
Reporting into the Chief Actuary, the Vice President of Actuarial Services is a key member of the Finance management team whose responsibility is to lead both the strategic and daily financial analytic functions for the Plan’s multiple product lines. These responsibilities include pricing, reserving, and financial planning across all of BMCHP’s lines of business. The candidate will manage all aspects of medical budget development including trend and member forecast. The Vice President of Actuarial Services will also work closely with Executive Team to set long term strategic direction for the organization.
Directs data analysis and development of actuarial assumptions to establish revenue requirements for budgeting and purchaser bids.
Oversees and provides strategic direction to support the pricing and premium development process for BMCHP’s commercial business lines.
Directs the monthly and annual reserving process, including IBNR reserves and additional actuarial accruals.
Directs financial/claim analysis reports to support complex Product Development decisions; applies risk adjustment methodologies in analysis.
Serves as ambassador for BMCHP Finance in communications and negotiations with key external partners such as state agencies and auditors.
Develops and implements plans to measure and report on corporate-wide health care delivery cost and utilization trends; collaborates with corporate experts in developing sound methodology for forecasting trends (participates in corporate trend team).
Responsible for financial oversight of risk adjustment operations for all product lines, ensuring integrity and optimization of the organization’s revenue streams.
Directs BMC system-wide analytic modeling, including development of recommendations to optimize the value of system and health plan initiatives.
Leads actuarial modeling and risk analysis related to ORSA, serving as key contributor and advisor within BMCHPs Enterprise Risk Management (ERM) governance.
Directs the design, development and implementation of evaluation tools in measuring the effectiveness of both internally developed medical management initiatives or externally purchased vendor programs. Provides expertise on build vs. buy decisions.
Leverages predictive modeling for analysis and operational applications.
Defines the information needs for customers and executes a vision for the delivery of analytic solutions. Key partner for Business Intelligence and Health Cost Analytics.
Collaborates with Medical Management to develop algorithms used to identify members for disease management programs. Conducts company-wide trend analysis and forecasting.
Responsible for supporting corporate initiatives/projects that require analysis of health plan data.
Directs the supervision of the Actuarial Services and Financial Planning team to include hiring, work allocation, scheduling, training and professional development, problem resolution, performance evaluation and related supervisory activities.
Directs a team of 10-15 people
General supervision is received weekly.
Bachelor’s Degree in Finance, Health Care Administration, or related field required.
Master’s Degree in a related field is strongly preferred.
Actuarial designation such as Fellow of the Society of Actuaries (FSA) or Member of the American Academy of Actuaries (MAAA) preferred.
Ten or more years progressively responsible experience data management and actuarial analysis with a minimum of four years in a management position within a healthcare insurance environment required.
Certification or Conditions of Employment:
Pre-employment background check
Competencies, Skills, and Attributes
Ability to simplify and communicate complex materials for executive audiences.
Ability to use well developed interpersonal skills to lead and direct the efforts of others, both internally and externally required.
Must be able to conceptualize and envision the impact of change, and propose new ways to do business. Strong analysis skills are required.
Ability to meet deadlines, multi-task, problem solve and use appropriate technology to analyze business problems. Project management skills a plus.
Excellent project management leadership skills.
Ability to lead and develop a team
Strong communications skills, both verbal and written, are required.
Working Conditions and Physical Effort:
Ability to work OT during peak periods.
Boston Medical Center HealthNet Plan
Website : http://www.bmchp.org/
Boston Medical Center (BMC) HealthNet Plan is a not-for-profit managed care organization serving more than 250,000 members across Massachusetts. The health plan serves members across three product lines: MassHealth, Commonwealth Care, and commercial (Employer Choice/Commonwealth Choice). BMC HealthNet Plan’s MassHealth plan has been named one of the top ten Medicaid health plans in America according to the National Committee for Quality Assurance (NCQA) ’s Medicaid Health Insurance Plan Rankings 2010-2013 and U.S. News/NCQA America’s Best Health Insurance Plans 2009-2010*. The Plan’s MassHealth product has also maintained Excellent Accreditation status from NCQA since first being accredited in 2009.