UPMC Health System
Manager - Actuarial Services
Ensures that the Actuarial Department provides excellent services to various internal and external clients in the areas of pricing, reserving, forecasting, benefits and product development, provider relations/contracting, underwriting, and compliance. Responsible for supervising actuarial analysts. Responsible for stat and federal filings including actuarial certification. Presents to senior financial leadership team.
Advise Health Plan senior management on the financial impact of any special pricing or contract arrangements which may affect Health Plan financial profitability.
Ascertain and comply with filing and actuarial requirements for participation in government-sponsored health plans as appropriate.
Develop product pricing levels, factors, and methods to ensure premium and revenue flow adequate to cover medical and administrative costs and profit margins for the various product lines consistent with corporate strategic goals.
Direct the development and assessment of underwriting methods and tools in order to enhance the ability of underwriting staff to accurately identify and quantify risk to produce price quotes which appropriately match premium to risk.
Ensure that all required statutory rate filings are submitted appropriately and that all rates, factors, and methods are in compliance with applicable state and federal regulations.
Ensure that departmental work products meet the highest standards of quality.
Provide Health Plan senior management with regular and ad hoc reports which communicate current and future near and long-term projections of financial performance of the various product lines in order to facilitate corporate decisions and the development of corporate strategies and goals.
Provide appropriate UPMC management with actuarial valuations of the impact of any proposed benefit changes or new product designs on an as-needed basis.
Provide pricing tools to enable Underwriting personnel to produce accurate price quotes on request from Sales and Marketing staff in a timely basis, along with appropriate supportive documents that may be needed to facilitate sales.
Provide reports for the purpose of evaluating and advising Health Plan management on the financial impact of proposed provider agreements or changes to existing agreements on an as-needed basis.
Supervise Actuarial and Underwriting department personnel to ensure that departmental objective and goals are achieved in a timely manner.
Work closely with the underwriting department.
Work with Federal, State and regulatory auditors to resolve discrepancies.
Work with the Health Plan-appointed actuary to ensure satisfactory filings of annual Statements of Actuarial Opinion and associated memorandum.
Work with the financial reporting department to develop reserve amounts for IBNR claims, active claims, and premium deficiency reserves on a regular or as-needed basis.
Bachelor's degree in mathematics, statistics, actuarial science, economics, or related field required. Advanced degree preferred.
Six and a half years of experience in progressively more responsible actuarial work in health insurance/managed care or equivalent training/education.
Experience with commercial and government health programs preferred.
In-depth understanding of health insurance market dynamics.
Excellent problem-solving and analytical skills. Good oral and written communication skills.
Strong PC skills.
Data retrieval skills and relational database experience.
Management experience preferred.
Licensure, Certifications, and Clearances:
Licensure/Certification: ASA or FSA certification by Society of Actuaries required. Membership in the American Academy of Actuaries required.
UPMC is an equal opportunity employer. Minority/Females/Veterans/Individuals with Disabilities
UPMC Health System
Website : http://www.upmc.com