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Position:

Director, Actuary

Position Summary:

Responsible for providing strategic direction for the planning and monitoring of financial risk for the organization and clients. Provides expert actuarial advice and review. Develops or approves actuarial models and assumptions to be used for costing, valuation, or analysis based on an understanding of the organization’s business goals. Responsibilities include but may not be limited to: Bid development and submission, guiding and development of team members, and data review of premium rate, provider contract, & reserve calculations.

Job Description:

Primary Responsibilities

• Provides strategic direction for the function. Coaches, mentors, motivates, supports, and develops junior team members. Supports goal setting/review, regular guidance and 1-1 check ins, career development/planning, upskilling, resource allocation, staffing, budget management, DE&I initiatives, and other People & Culture programs/activities as needed. Fosters accountability and collaboration to ensure team member and overall team success.

• Develops the organization’s premium rate structure through the forecasting of financial/statistical data in a manner which is actuarially sound and in line with trends in the marketplace including cash flow analysis and financial projections.

• Guides actuarial activities and services in support of medical data reviews, trend projections, and rate negotiations.

• Accountable for financial and claims data to evaluation to utilize and unit price trends.

• Assists with and participates in negotiations and presentations where appropriate.

• Owns and guides projects involving development of Medicare Advantage and Part D bids.

• Assists in annual reserve calculations and financial statement filings.

• Assists in monthly calculation of reserves and financial reporting.

• Develops pricing consistent w/ financial and business goals.

• Develops and applies actuarial models to diverse client situations.

• Balances growth and profitability goals to maximum results.

• Designs and oversees ad hoc health cost analyses.

• Responsible for training and education of team members.

• Owns and guides client projects.

Qualifications

• Bachelors degree or equivalent

• ASA or FSA

• 12+ years of relevant experience or the knowledge, skills, and abilities to succeed in the role

• Excellent project management skills

• Ample healthcare industry experience; preferred 5 years

• Highly skilled with Medicare Advantage bid preparations/desk review

• Strong interpersonal and communication skills including oral presentations and written reports

• Advanced knowledge and experience with complex actuarial projects that have a large financial and risk impact

• Technical proficiency in all aspects of health care actuarial practice including pricing, reserving, and data reporting

• Ability to directly or indirectly coach, support, develop, and mentor junior team members

Working Conditions

• While performing the duties of this job, the employee works in normal office working conditions.

Disclaimer

• The job description describes the general nature and level of work being performed by people assigned to this job and is not intended to be an exhaustive list of all responsibilities, duties and skills required. The physical activities, demands and working conditions represent those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential job duties and responsibilities.

Lumeris is an EEO/AA employer M/F/V/D.

The hiring range for this position is:

Factors that may be used to determine your actual pay rate include your specific skills, experience, qualifications, location, and comparison to other employees already in this role. This role may also be eligible for incentive compensation. At Lumeris, we are committed to providing a total rewards package that supports your overall well-being. Our benefits include medical, vision, dental, well-being programs, 401(k) with company matching, life insurance, paid time off including paid leave, and so much more. Learn more by visiting our Careers Page () .

Member Facing Position:

No- Not Member or Patient Facing Position

Location:

Remote, USA

Time Type:

Full time

Lumeris and its partners are committed to protecting our high-risk members & prospects when conducting business in-person. All personnel who interact with at-risk members or prospects are required to have completed, at a minimum, the initial series of an approved COVID-19 vaccine. If this role has been identified as member-facing, proof of vaccination will be required as a condition of employment.

Join Our Growing Team!

Lumeris is bringing common sense back to the business of healthcare by empowering value-based care. We create the partnerships and perspectives that are making healthcare safer, more affordable and more personalized for providers, patients and payers alike.

We were founded on the belief that it should be easier to provide the right care, at the right time, at the right cost. Our model is bringing that belief to life, improving outcomes and empowering financial sustainability along the way.

Why Join Lumeris?

At Lumeris, you will be part of team that is focused on solving the nation’s healthcare problem, and you will be able to contribute to our purpose. Our environment is fast-paced, change-oriented and focused on growth and employee engagement. At Lumeris, we know that talent is best utilized when given the opportunity to succeed. That is why we have removed the boundaries that inhibit success and focus on fostering an environment that allows employees to utilize their talents.