Senior Network Pricing Actuary

Job Summary:

The Senior Network Pricing Actuary is part of the growing Network Pricing team, which partners with the national and local market Provider Contracting teams to ensure our contract negotiations, network strategy, and understanding of our network performance are informed by reliable data and modeling.

This role serves as the regional lead, responsible for work including: coordinating and presenting analyses to influence our negotiation strategy for major deals; coordinating and performing modeling to support major negotiations; facilitating market network performance management forums, bringing insights into network performance drivers and opportunities, and driving accountability; and partnering with the provider contracting and delivery system teams to develop the network strategy. This is a leadership level role that will engage regularly with the VPs of provider contracting, the market CFOs, and the regional health plan SVP. While not having any direct reports, this role will partner closely with the network pricing analysts in the team, delegating analysis and providing guidance and coaching.

The work will require knowledge and experience of provider contracting, network strategy, and how they impact unit cost trends and product & network financial performance.

Essential Responsibilities:

• Practices self-leadership and promotes learning in others by soliciting and acting on performance feedback; building collaborative, cross-functional relationships; communicating information and providing advice to drive projects forward; adapting to competing demands and new responsibilities; providing feedback to others, including upward feedback to leadership; influencing, mentoring, and coaching team members; fostering open dialogue amongst team members; evaluating and responding to the strengths and weaknesses of self and unit members; and adapting to and learning from change, difficulties, and feedback.
• Drives the execution of multiple work streams by identifying customer and operational needs; developing and updating new procedures and policies; gaining cross-functional support for objectives and priorities; translating business strategy into actionable business requirements; obtaining and distributing resources; setting standards and measuring progress; removing obstacles that impact performance; guiding performance and developing contingency plans accordingly; solving highly complex issues; and influencing the completion of project tasks by others.
• Leads actuarial documentation and reporting by coordinating the completion of the actuarial portion of financial reports and tax returns, and responses to insurance regulations; and presenting results internally and externally to senior leadership.
• Leads product line evaluations by coordinating analysis of product line financials, pricing, reserve, valuation , cash flow analysis, and product investment strategy; and making recommendations based on product line performance, risk, and assumptions used in product development.
• Furthers actuarial research by identifying the needs and implementing complex methods to advance the actuarial techniques, standards, assumptions, and the legal and regulatory environment.
• Monitors financial risks and opportunities by developing advanced and non-traditional actuarial methods; and leveraging industry knowledge to conduct and determine actuarial analyses.
• Influences senior business partners by translating complex actuarial constructs into actionable recommendations; and initiating actuarial and financial advice in compliance with the Actuarial Standards of Practice.
• Identifies needs and provides guidance on how to build framework and assumptions for new, existing, and non-traditional actuarial models to meet business needs.