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Vice President, Actuarial and Underwriting

Company: Brigham and Women’s Hospital
Location: Somerville
Posted on: September 12, 2020

Job Description:

Job Description - Vice President, Actuarial and Underwriting (3124387)

Vice President, Actuarial and Underwriting - ( 3124387 )

A career at AllWays Health Partners is you in every way! Inspired by our affiliation with Partners HealthCare, our promise as a people-first organization starts with our employees. Get inspired to bring your unique talents to our diverse community and challenge the health care industry status quo with innovative programs that put people first. Our perks include a competitive benefits package, access to world-class doctors, and more.

Under the broad direction of the Deputy Chief Financial Officer and Chief Actuary, the Vice President, Actuarial and Underwriting has overall organizational responsibility for the Actuarial and Underwriting functions of the organization including development, communication, and implementation of the actuarial and underwriting strategies and practices.

The Vice President, Actuarial and Underwriting is responsible for setting reserves, developing commercial premium rates and methodology and analyzing medical trends for AllWays Health Partners. They will be responsible for developing monthly outstanding claim liability reserves for all lines of business and developing and supervising the actuarial and underwriting functions. The Vice President, Actuarial and Underwriting will be responsible for developing and maintaining rate formulas and models for all necessary rate filings for the commercial line of business, as well as underwriting guidelines, models, and factors for large group rating. They will collaborate with Sales and Marketing on the development of rating and underwriting policies to meet financial and sales goals. They will be a key player in the development and expansion of the commercial line of business. In addition they will be responsible for analyzing underlying cost and utilization trends for the commercial line of business and the plan as a whole, and assessing the actuarial soundness of Medicaid rates.

Essential Functions:

• Directs the calculation of risk and pricing for products and services provided by the health plan.

• Works closely with Strategy and Marketing, Finance, Medical Economics, Product, Sales and other actuarial and underwriting staff.

• Develops rate formulas, models, and underwriting guidelines for the Commercial line of business.

• Uses rate formulas, models, and underwriting guidelines to calculate rates for Commercial accounts.

• Manages Commercial account profitability through quarterly reporting, monitoring of actual vs. budgeted rates, and other activities.

• Files Commercial rates in accordance with state requirements.

• Assists Sales in delivering rates to Commercial accounts as needed.

• Provides claim experience to Commercial accounts as needed.

• Calculates unpaid claim liabilities monthly and other accruals to ensure accuracy of financial statements.

• Participates in MassHealth rate negotiations and other financial activities as needed.

• Assists in the evaluation of reinsurance programs and other corporate insurance as needed.

• Assists in the development of new products as needed.

• Manages and provides appropriate Actuarial support to corporate initiatives and projects.

• Serves as the Partners HealthCare subject matter expert on premium revenue, insurance risk, and trend forecasting including:

• Developing corporate wide best practices on forecasting and monitoring medical trend.

• Developing best practice and practical provider risk models.

• Developing a methodology to have consistent treatment of reserves and financial forecasts across Partners HealthCare by understanding correlations between the insurance and provider divisions.

• Understanding the enterprise risk of Partners HealthCare including but not limited to insurance division and provider side risk contracts.

• Working with organizations to understand the difference between system wide optimization and optimization for individual Partners HealthCare entities.

• Anticipates and meets, or exceeds, internal and/or external customer expectations and requirements; establishes and maintains effective relationships with customers and gains their trust and respect.

• Informs, engages, inspires, motivates, and actively listens to employees.

• Identifies and develops processes and aligns resources to accomplish key objectives; clearly conveys and assigns accountability for objectives, deadlines, and expectations.

• Sets clear goals and objectives, uses metrics to measure performance, and hold employees accountable.

• Ensures diversity, equity, and inclusion are integrated as a guiding values.

Department Specific Functions:

• Other duties as assigned with or without accommodation.

Working Conditions and Physical Effort:

• Work is normally performed in a typical office work environment.

Knowledge and Education: Required: • Undergraduate Degree or the equivalent combination of training and experience • FSA and MAAA required Preferred/Desired: • Masters preferred • Expert in use of spreadsheets and knowledge of databases in general

Experience: Required: • 10 plus years of work experience with several years of experience in managed healthcare required. • At least 3 years of experience with premium rate and benefit pricing methodologies. • Demonstrated forecasting and medical trend experience. • Must meet Qualification Standards for Actuaries Issuing Statements of Actuarial Opinion in the United States (US Qualification Standard) Skills/Competencies: • Demonstrate AllWays Health Partners’ core brand principles of always listening, challenging conventions, and providing value. • Bring fresh and innovative ideas forward by listening to and working with employees and the people we serve. • Strong, demonstrated track record of an ability to execute on time, on budget, and on scope. • Strong aptitude for technology-based solutions. • Current in healthcare and health plan trends. • Demonstrated forward, visionary thinking; ability to see “what is” and envision “what could be.” • Ability to develop, introduce, defend, and gain support for a new ideas and approachess. • Excellent leadership skills and leadership track record. • Ability to translate and communicate complex topics in a variety of forums, tailoring communications to effectively fit and influence the targeted audience. • Strong verbal, active listening, and written communication skills. • Demonstrated ability to apply a variety of strategic frameworks to analyze problems and to guide and develop solutions. • Ability to challenge the status quo and drive innovative thinking and the capability to successfully implement strategy. • Excellent interpersonal skills, including the ability to influence others at all levels of an organization. • Strong EQ; exercises self-awareness; monitors impact on others; is receptive to and seeks out feedback; uses self-discipline to adjust to feedback. EEO Statement Our promise as a people-first organization starts with our employees. AllWays Health Partners is committed to diversity, equity, and inclusion in our workforce, internal culture, and investments. As an equal opportunity employer, AllWays Health Partners recognizes the power of a diverse community and encourages applications from individuals with varied experiences, perspectives, and backgrounds.

Primary Location MA-Somerville-Allways Health Partners at Assembly Row

Work Locations Allways Health Partners at Assembly Row

Job Finance/Accounting

Organization AllWays Health Partners

Schedule Full-time

Standard Hours 40

Shift Day Job

Employee Status Regular

Keywords: Brigham and Women’s Hospital, Somerville , Vice President, Actuarial and Underwriting, Other , Somerville, Massachusetts

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