Job Category: Chief Actuary
Job Type: Full Time Onsite
Job Location: Tennessee
We are seeking an experienced and analytical Chief Actuary to provide critical support across reserving, forecasting, and decision-making functions, while collaborating with Operations, Clinical, and Finance teams. This role is ideal for a motivated professional eager to address complex medical economics questions using diverse data sources. The position offers a fast-paced environment that fosters professional growth and development.
Key Duties and Responsibilities
- Develop, refine, and maintain reserve/IBNR models for financial close and analysis.
- Provide medical expense projection models for budgeting and forecasting purposes.
- Analyze healthcare cost drivers by market segment and provider, focusing on utilization patterns, referral behavior, and reimbursement rates.
- Research healthcare delivery topics, analyze data, and recommend actionable solutions to address business challenges.
- Align the actuarial function with business objectives by developing and implementing strategy and success metrics.
- Lead and mentor team members, fostering professional growth and development.
- Monitor claims, membership, and prior authorization data to identify trends impacting medical costs and quality of care.
- Provide actuarial support by identifying trends and profitability drivers through statistical analysis.
- Utilize expertise with HCCs (Hierarchical Condition Categories) and RAFs (Risk Adjustment Factors) to project revenue.
- Present analytical findings in clear, organized, and actionable visual formats.
- Collaborate with the Engineering team to source credible data, create user-friendly reports, and apply advanced analytical techniques.
- Address ad-hoc requests from stakeholders and deliver solutions aligned with business objectives.
- Interpret contractual language, ensuring alignment with business rules and reporting requirements.
- Undertake special projects to enhance knowledge, skills, and organizational performance.
Required Skills and Attributes
- Ability to independently research and develop solutions to complex problems.
- A collaborative and independent approach to performing complex analyses.
- Strong critical thinking skills to anticipate stakeholder questions and address all aspects of analyses.
- Initiative and curiosity in exploring opportunities to improve performance through data insights.
- Proven ability to build trust and professional relationships with senior stakeholders.
Minimum Qualifications
- Bachelor’s degree in Applied Math, Statistics, Actuarial Science, Economics, or related fields.
- Associate of the Society of Actuaries (ASA) designation required.
- At least 10 years of actuarial experience, with 5+ years in a leadership role within a health plan, ACO, RBE, or consulting firm.
- Experience with Medicare Advantage Bids and CMS HCC Models.
- Proficiency in MS Excel, including PivotTables, Power BI, graphing, and reporting tools.
- Preferred experience collaborating with IT teams to procure datasets and performing data mining on large repositories (SQL expertise strongly preferred).
- Expertise in creating statistically valid product trend analyses.
