Actuarial Services Director jobs in Oregon

Candidates hired for remote positions must reside in Oregon, Washington, Utah, Idaho, Arizona, Nevada, Texas, Montana, or Wisconsin.

Job Summary

This position is responsible for managing the actuarial components of financial reporting and analysis cycles within the organization. This includes providing actuarial estimates of Incurred But Not Reported (IBNR) liabilities and other assets and liabilities, analyzing trends, identifying deviations from benchmarks and the resulting financial impacts, forecasting changes in health care cost and utilization patterns, estimating and calculating the return on investment of proposed and implemented initiatives, completing required regulatory reporting, and communicating results and findings from actuarial analyses within CareOregon. Primary duties include technical and operational management, as well as relationship and people management. This position provides input into strategic plans for the broader organization.

Essential Responsibilities

Technical/Operational Management

• Work with the Director, Actuarial Services to manage the development and communication of actuarial analysis related to financial reporting in alignment with organizational vision and goals.
• Develop and maintain models to determine actuarial estimates of IBNR, Premium Deficiency Reserve (PDR) liabilities, and other assets and liabilities; manage regular processes to ensure financial reporting deadlines are met.
• Develop and maintain actuarial cost models to perform cost and utilization analysis; identify and explain key drivers of historical trends; gather and develop benchmarks for purposes of assessing performance and the potential for improvement.
• Lead trend forecasting for use in budgeting; work with Financial Planning & Analysis team to set budgeted utilization and cost targets and evaluate actual results against budget.
• Analyze financial performance and work with LOB Finance team to communicate results and drivers of historical and forecasted performance to business leaders; identify opportunities to influence current and future outcomes.
• Create models of proposed interventions for use in goal setting, budgeting, and forecasting.
• Oversee the design, development, and implementation of evaluation tools to measure the effectiveness and ROI of various programs.
• Drive strategic use of data to support business efficiencies and competitive decision-making.
• Ensure the timely completion of assigned regulatory reporting for CMS and OHA.

Relationship Management

• Communicate effectively, encouraging and creating a collaborative culture within Strategic Finance and cross-functionally.
• Build and ensure effective relationships across internal teams and external organizations for current or future integration.
• Partner with internal leaders and managers in identifying improvement plans and processes.

Employee Supervision

• Manage team(s) and recommends team direction and goals in alignment with the organizational mission, vision, and values.
• Identify work and staffing needs to meet work expectations; recruit and hire, using an equity, diversity, and inclusion lens.
• Plan, organize, schedule, and monitor work; ensure employees have information and resources to meet job expectations.
• Participate in 1:1, team, and department meetings; attend all staff meetings.
• Lead the development, communication, and oversight of team and individual goals; ensure goals, expectations, and standards are clearly understood by staff.
• Train, supervise, motivate, and coach employees; provide support toward employee development.
• Incorporate guidance from CareOregon equity tools into people leadership, planning, operations, evaluation, and decision making.
• Ensure team adheres to department and organizational standards, policies, and procedures.
• Evaluate employee performance and provide regular feedback to support success; recognize strong performance and address performance gaps and accountability (corrective action).
• Perform supervisory tasks in collaboration with Human Resources as needed.

Organizational Responsibilities

• Perform work in alignment with the organization's mission, vision and values.
• Support the organization's commitment to equity, diversity and inclusion by fostering a culture of open mindedness, cultural awareness, compassion and respect for all individuals.
• Strive to meet annual business goals in support of the organization's strategic goals.
• Adhere to the organization's policies, procedures and other relevant compliance needs.
• Perform other duties as needed.

Experience and/or Education

Required

• Minimum 5 years' experience in actuarial services related to health care
• Work experience in health insurance
• Associate of the Society of Actuaries

Preferred

• Minimum 2 years' experience in a supervisory position or minimum 1 year experience in a supervisory position with completion of CareOregon's Aspiring Leaders Program
• Fellow of the Society of Actuaries
• Experience with Medicaid and Medicare
• Experience estimating IBNR, risk adjustment transfers, and other health care liabilities and assets
• Experience analyzing health care cost and utilization data

Knowledge, Skills and Abilities Required

Knowledge

• Extensive knowledge of managed care and the Oregon Health Plan
• Knowledge of various methods of estimating IBNR and other reserves
• Ability to construct and use actuarial cost models for performing cost and utilization, trend, and benchmarking analysis
• Understanding of how to model direct and indirect financial impacts in a complex system
• Strong understanding of data systems and relational databases

Skills and Abilities

• Proficient with SAS, SQL, and/or R

• Advanced Excel skills
• Excellent critical thinking and problem-solving skills
• Effective leadership skills and advanced understanding of managerial concepts and techniques in areas such as work planning, training, delegating, coaching, mentoring, and evaluating staff
• Ability to develop and assess actuarial analyses and models pertaining to managed care
• Ability to communicate effectively, both verbally and in writing, including strong presentation skills
• Ability to develop and lead high performing team members, including hiring, goal setting, coaching, performance management, and career development
• Ability to develop and maintain Tableau dashboards
• Ability to work with eligibility data, claims data, risk scores, and other financial data
• Ability to work in an environment with matrix reporting, diverse individuals, and groups
• Ability to identify, implement, and manage process improvements
• Ability to learn, focus, understand, and evaluate information and determine appropriate actions
• Ability to accept direction and feedback, as well as tolerate and manage stress
• Ability to see, read, hear, speak clearly, and perform repetitive finger and wrist movement for at least 6 hours/day

Working Conditions

Work Environment(s): Indoor/Office Community Facilities/Security Outdoor Exposure

Member/Patient Facing: No Telephonic In Person

Hazards: May include, but not limited to, physical and ergonomic hazards.

Equipment: General office equipment

Travel: May include occasional required or optional travel outside of the workplace; the employee's personal vehicle, local transit or other means of transportation may be used.

#Li-Remote

Candidates of color are strongly encouraged to apply. CareOregon is committed to building a linguistically and culturally diverse and inclusive work environment.

Veterans are strongly encouraged to apply.

We are an equal opportunity employer. CareOregon considers all candidates regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, genetic information, disability, or veteran status.

Visa sponsorship is not available at this time.