Overview
Serves as key resource and leads, on actuarial services for VNS Health Plans product lines. Provides quantitative support to VNS Health Plans Finance Department and Actuarial Services team, through a broad range of responsibilities including pricing, reserving, research, data analysis, financial reporting, documentation, and the development of a controlled actuarial environment. Works under general supervision.
What We Provide
- Referral bonus opportunities
- Generous paid time off (PTO), starting at 30 days of paid time off and 9 company holidays
- Health insurance plan for you and your loved ones, Medical, Dental, Vision, Life and Disability
- Employer-matched retirement saving funds
- Personal and financial wellness programs
- Pre-tax flexible spending accounts (FSAs) for healthcare and dependent care
- Generous tuition reimbursement for qualifying degrees
- Opportunities for professional growth and career advancement
- Internal mobility, generous tuition reimbursement, CEU credits, and advancement opportunities
What You Will Do:
- Manages monthly IBNR development and other liability valuations. Reconciles claims data with the general ledger to identify and explain discrepancies. Automates and modernizes valuation models and processes. Communicates reserving recommendations and P&L impacts to senior management.
- Leads key quantitative and qualitative analyses, including cost and utilization tracking, Medical Loss Ratio (MLR) reporting, reconciliations, and member cohort analyses.
- Serves as the actuarial project lead for all regulatory entities, including the Centers for Medicare & Medicaid Services (CMS), National Association of Insurance Commissioners (NAIC), Department of Health (DOH), rate reviewers, auditors, and other regulatory agencies. Oversees the collection and preparation of materials used in audit-related activities.
- Supports the annual Medicare bid process, including data collection and cleansing, trend development, and financial reconciliation.
- Maintains and modernizes a comprehensive Medical Loss Ratio (MLR) database to monitor and analyze member-level revenue, medical expenses, and administrative costs.
- Liaises with internal departments to establish and maintain strong lines of communication across all areas impacting actuarial functions.
- Performs all duties inherent in a managerial role, including ensuring effective staff training, interviewing candidates for employment, evaluating staff performance, conducting annual performance appraisals, and recommending hiring, promotions, salary actions, and terminations, as appropriate.
- Participates in special projects and performs other duties as assigned.
Qualifications
Licenses and Certifications:
Associate of the Society of Actuaries (ASA) designation preferred
Education:
Bachelor's Degree in Mathematics, Actuarial Science, Statistics, Biostatistics, or related discipline required
Work Experience:
- Minimum of six years of progressively responsible actuarial experience in a Health Plan, Managed Care organization, or similar environment, including supervisory experience. Medicare and Medicaid experience preferred.
- Expert knowledge of Actuarial Standards of Practice (ASOPs), Centers for Medicare & Medicaid Services (CMS), National Association of Insurance Commissioners (NAIC), and core health actuarial processes, including valuation, financial reconciliation, and budgeting/forecasting. Required
- Experience composing and facilitating presentations. Required
- Demonstrated proficiency in manipulating and analyzing large, complex datasets from multiple sources using Snowflake and Python. Required
- Proficiency in Microsoft Excel. Required
- Ability to communicate quantitative analyses and results in a clear, concise, and actionable manner. Required
Pay Range
USD $109,900.00 - USD $146,500.00 /Yr.
About Us
VNS Health has been committed to meeting the needs of New Yorkers for over 130 years. We're one of the largest nonprofit home- and community-based health care organizations in the country, and today, more than 11,500 team members work together to make a difference in the lives of more than 99,000 patients and members on any given day.