Actuary, Risk and Compliance - Humana
Providence, RI
About the Job
Become a part of our caring community and help us put health first
This Actuary role is a role within the Senior Products Actuarial Compliance team focused on special Medicare Advantage programs, including Value Based Insurance Design (VBID), Special Supplemental Benefits for the Chronically Ill (SSBCI) and other innovating pilots. In this role, you will have a unique opportunity to provide guidance and collaborate with business partners and leadership on these growing and expanding programs. In addition to detailed involvement in special programs, this role supports compliance of Medicare bid filings and allows you to see the overall end to end bid process at a leading Medicare Advantage organization. This is a great role for a collaborative individual who is detail oriented and enjoys being part of a team that is at the center of a changing regulatory landscape.
The Actuary, Risk and Compliance role assesses and communicates information regarding actuarial/business risks across the organization. Provides peer review and counsel on a wide variety of company, industry, and regulatory practices. Activities will include monitoring and researching laws and regulations applicable to Medicare Advantage and actuarial science. Advises certifying actuaries, executives, and non-actuarial business partners on Value Based Insurance Designs (VBIDs), Special Supplemental Benefits for the Chronically Ill (SSBCI) and other innovating pilots. Exercises independent judgment and decision making to determine the best course of action and recommends controls to mitigate risks on these programs.
In addition to the special programs this specific role will be part of a team tasked with assessment of risk, opportunities, and mitigation strategies to assure the compliant submission of bids to support Humana's pricing and product development of Medicare Advantage and Prescription Drug Plans that positively impact the financial performance of Humana.
+ Supporting Humana’s MA-PD and PDP bid filings by ensuring appropriate interpretation and implementation of CMS guidance, and implementation and execution of review standards and controls to minimize compliance risk associated with the bid filing
+ Participate in CMS audits and reviews related to Humana’s Medicare bids.
+ Create and maintain process improvements to bid filings to continually improve Humana's ability to file compliant bids.
Use your skills to make an impact
Required Qualifications
+ Bachelor's degree
+ 7 or more years of technical experience
+ 2 or more years of project leadership experience
+ MAAA: FSA preferred, or ASA with commensurate years of experience
+ Demonstrated ability to communicate as a leader and to communicate with other areas of the business
+ Experience conveying complex analyses and concepts to non-technical audiences and leaders
+ Demonstrated interest in learning new things
+ Proven ability to exercise independent judgment and thinking on complex issues
Preferred Qualifications
+ Medicare Advantage and/or Part D experience
+ Demonstrated ability to manage large projects involving actuarial and non-actuarial staff
+ Experience in reviewing and interpreting regulatory documents
+ Demonstrated ability to assess risks
+ Experience developing controls to mitigate risks
Scheduled Weekly Hours
40
Pay Range
The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.
$126,800 - $174,500 per year
This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.
Description of Benefits
Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.
About us
Humana Inc. (NYSE: HUM) is committed to putting health first – for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.
Equal Opportunity Employer
It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or veteran status. It is also the policy of Humana to take affirmative action to employ and to advance in employment, all persons regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.
Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our https://www.humana.com/legal/accessibility-resources?source=Humana_Website.
This Actuary role is a role within the Senior Products Actuarial Compliance team focused on special Medicare Advantage programs, including Value Based Insurance Design (VBID), Special Supplemental Benefits for the Chronically Ill (SSBCI) and other innovating pilots. In this role, you will have a unique opportunity to provide guidance and collaborate with business partners and leadership on these growing and expanding programs. In addition to detailed involvement in special programs, this role supports compliance of Medicare bid filings and allows you to see the overall end to end bid process at a leading Medicare Advantage organization. This is a great role for a collaborative individual who is detail oriented and enjoys being part of a team that is at the center of a changing regulatory landscape.
The Actuary, Risk and Compliance role assesses and communicates information regarding actuarial/business risks across the organization. Provides peer review and counsel on a wide variety of company, industry, and regulatory practices. Activities will include monitoring and researching laws and regulations applicable to Medicare Advantage and actuarial science. Advises certifying actuaries, executives, and non-actuarial business partners on Value Based Insurance Designs (VBIDs), Special Supplemental Benefits for the Chronically Ill (SSBCI) and other innovating pilots. Exercises independent judgment and decision making to determine the best course of action and recommends controls to mitigate risks on these programs.
In addition to the special programs this specific role will be part of a team tasked with assessment of risk, opportunities, and mitigation strategies to assure the compliant submission of bids to support Humana's pricing and product development of Medicare Advantage and Prescription Drug Plans that positively impact the financial performance of Humana.
+ Supporting Humana’s MA-PD and PDP bid filings by ensuring appropriate interpretation and implementation of CMS guidance, and implementation and execution of review standards and controls to minimize compliance risk associated with the bid filing
+ Participate in CMS audits and reviews related to Humana’s Medicare bids.
+ Create and maintain process improvements to bid filings to continually improve Humana's ability to file compliant bids.
Use your skills to make an impact
Required Qualifications
+ Bachelor's degree
+ 7 or more years of technical experience
+ 2 or more years of project leadership experience
+ MAAA: FSA preferred, or ASA with commensurate years of experience
+ Demonstrated ability to communicate as a leader and to communicate with other areas of the business
+ Experience conveying complex analyses and concepts to non-technical audiences and leaders
+ Demonstrated interest in learning new things
+ Proven ability to exercise independent judgment and thinking on complex issues
Preferred Qualifications
+ Medicare Advantage and/or Part D experience
+ Demonstrated ability to manage large projects involving actuarial and non-actuarial staff
+ Experience in reviewing and interpreting regulatory documents
+ Demonstrated ability to assess risks
+ Experience developing controls to mitigate risks
Scheduled Weekly Hours
40
Pay Range
The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.
$126,800 - $174,500 per year
This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.
Description of Benefits
Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.
About us
Humana Inc. (NYSE: HUM) is committed to putting health first – for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.
Equal Opportunity Employer
It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or veteran status. It is also the policy of Humana to take affirmative action to employ and to advance in employment, all persons regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.
Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our https://www.humana.com/legal/accessibility-resources?source=Humana_Website.
Source : Humana
