It’s an exciting time to join the WellSense Health Plan, a growing regional health insurance company with a 25-year history of providing health insurance that works for our members, no matter their circumstances.

The Actuarial Manager is a key member of the Finance / Actuarial Services team. As a team leader and a Subject Matter Expert, the Actuarial Manager leads or oversees actuarial functions for pricing, reserving, medical economics, financial forecasting, and/or healthcare data analytics. The Actuarial Manager collaborates with Finance teams or other departments in the organization to oversee and assure a coordinated approach to the actuarial components of health programs and provides actuarial expertise to protect the organization’s financial integrity.

Our Investment in You:

• Full-time remote work
• Competitive salaries
• Excellent benefits

Key Functions/Responsibilities:

• Leads the rate development process by providing analyses and recommendations on benefit design, rating factors, trend picks, and projection of future claim cost.
• Oversees regulatory rate filings and prepares data or response for additional inquiries.
• Leads the development of monthly IBNR reserve estimates for different line of business.
• Oversees monthly accruals and contract settlements for different line of business.
• Leads financial budget, reforecast and other financial projections.
• Evaluates and makes recommendations regarding the adequacy of capitation rates from state Medicaid programs or other new program.
• Coordinates with various departments and cross-functional teams to capture, value, and scorecard medical cost savings initiatives.
• Leads risk adjustment analyses and risk score simulations.
• Leads trend development, trend drivers' study, and/or provider contract analytics.
• Maintains financial relationships with vendors and providers. Represents Finance in negotiations of financial terms to support network contracting strategy or outsourcing strategy.
• Develops analytic reports for internal needs and/or regulatory requirements.
• Initiates and leads efforts to improve quality and efficiency of actuarial models, analyses and reports.
• Summarizes findings and makes recommendations.
• Develops presentations and communicates to senior management or external parties.
• Leads response to internal and external audits.
• Serves as actuarial representative or SME for corporate initiatives/projects.
• Advises Finance department on data warehouse designs, requests and works with IT to implement or improve business processes.
• Drives organizational talent by retaining and developing colleagues and/or actuarial students.

Qualifications:

Education:

• Bachelor’s Degree in Mathematics, Actuarial Science, Finance, Economics or related fields.

Experience:

• More than 5 years of progressively responsible experience in actuarial analysis, data modeling, informatics and analysis.

Preferred/Desirable:

• A background in managed healthcare, insurance operations.
• 2+ years of prior experience managing a small team of analysts.
• Master’s degree.
• ASA or FSA

Competencies, Skills, and Attributes :

• Proficient in Excel, SQL, and SAS or other statistical software.
• Strong interpersonal skills to lead and direct the efforts of others, both internally and externally.
• Strong analysis skills. Must be able to conceptualize and envision the impact of change, and propose new ways to do business.
• Ability to meet deadlines, multi-task, problem solve and use appropriate technology to analyze business problems. Project management skills a plus.
• Strong communications skills, both verbal and written.

About WellSense

WellSense Health Plan is a nonprofit health insurance company serving more than 740,000 members across Massachusetts and New Hampshire through Medicare, Individual and Family, and Medicaid plans. Founded in 1997, WellSense provides high-quality health plans and services that work for our members, no matter their circumstances.

Required Skills

Required Experience