Lead Actuary, SPA-Rx Part B Pricing - Humana
Augusta, ME
About the Job
Become a part of our caring community and help us put health first
The Actuary, Analytics/Forecasting analyzes and forecasts financial, economic, and other data to provide accurate and timely information for strategic and operational decisions. Establishes metrics, provides data analyses, and works directly to support business intelligence. Evaluates industry, economic, financial, and market trends to forecast the organization's short, medium and long-term financial and competitive position. The Actuary, Analytics/Forecasting works on problems of diverse scope and complexity ranging from moderate to substantial.
Part B Pharmacy Pricing Lead Actuary
Part B Pharmacy Pricing
+ Own the Medicare Advantage (MA) Individual and Group benefit cost projections for the Part B pharmacy benefit. The lead actuary's team will review actual to expected data, build and maintain projection models, set forecast assumptions, and deliver projection results. The projections are used in the MA Parts A + B bid submissions and quarterly financial projections.
+ Prepare communications explaining results including live presentations and narrative descriptions to actuarial and financial leadership teams.
+ Develop and maintain a professional network that supports assumption development or other aspects of the pharmacy pricing process such as clinical pipeline, Humana Pharmacy Solutions (HPS) trade team, and benefit initiative scorecard team.
+ Act as the organizations accountable person for items involving Part B pharmacy, including bid submission substantiation and audit related requests.
PD/PDP Base Period Bid Development /Reconciliation
+ Coordinate with Milliman, Finance, Rx Actuarial, and MA Data Foundations to collect, organize, and develop the base period benefit and non-benefit data used in the Medicare bid submissions.
+ Manage data input process to ensure that all vendors are providing necessary inputs in appropriate formats.
+ Validate data by reconciling it to financial statements. Identify and explain differences between the processing and reporting required for the bids and required for the financial statements. Resolve discrepancies by capturing information from data source owners.
+ Allocate source data to the bid submission level as necessary.
+ In combination with data vendors, substantiate data development for auditors via reconciliations to audited material (ex: financial statements) and via responses to requests during bid and financial audits.
Audit Support
+ Develop responses to bid desk review, bid audit, and financial audit questions.
+ Lead actuary owns responses related to Part B pharmacy projection and Part D bid base period development.
+ Coordinates with data suppliers and compliance to develop detailed responses to audit requests.
The Actuary, Analytics/Forecasting ensures data integrity by developing and executing necessary processes and controls around the flow of data. Collaborates with stakeholders to understand business needs/issues, troubleshoots problems, conducts root cause analysis, and develops cost effective resolutions for data anomalies. Advises executives to develop functional strategies (often segment specific) on matters of significance. Exercises independent judgment and decision making on complex issues regarding job duties and related tasks, and works under minimal supervision, Uses independent judgment requiring analysis of variable factors and determining the best course of action.
Use your skills to make an impact
Required Qualifications
+ Bachelor's Degree
+ FSA or ASA certifications
+ MAAA
+ Strong communication skills
+ Experience in more than two functions (e.g., modeling, pricing, rate filing, reporting & analysis, reserving or trending)
Preferred Qualifications
+ Medicare experience
+ Additional relevant professional designations.
Work-At-Home Requirements
To ensure Home or Hybrid Home/Office associates’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office associates must meet the following criteria:
+ At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested
+ Satellite, cellular and microwave connection can be used only if approved by leadership
+ Associates who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.
+ Humana will provide Home or Hybrid Home/Office associates with telephone equipment appropriate to meet the business requirements for their position/job.
+ Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information
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.
The Actuary, Analytics/Forecasting analyzes and forecasts financial, economic, and other data to provide accurate and timely information for strategic and operational decisions. Establishes metrics, provides data analyses, and works directly to support business intelligence. Evaluates industry, economic, financial, and market trends to forecast the organization's short, medium and long-term financial and competitive position. The Actuary, Analytics/Forecasting works on problems of diverse scope and complexity ranging from moderate to substantial.
Part B Pharmacy Pricing Lead Actuary
Part B Pharmacy Pricing
+ Own the Medicare Advantage (MA) Individual and Group benefit cost projections for the Part B pharmacy benefit. The lead actuary's team will review actual to expected data, build and maintain projection models, set forecast assumptions, and deliver projection results. The projections are used in the MA Parts A + B bid submissions and quarterly financial projections.
+ Prepare communications explaining results including live presentations and narrative descriptions to actuarial and financial leadership teams.
+ Develop and maintain a professional network that supports assumption development or other aspects of the pharmacy pricing process such as clinical pipeline, Humana Pharmacy Solutions (HPS) trade team, and benefit initiative scorecard team.
+ Act as the organizations accountable person for items involving Part B pharmacy, including bid submission substantiation and audit related requests.
PD/PDP Base Period Bid Development /Reconciliation
+ Coordinate with Milliman, Finance, Rx Actuarial, and MA Data Foundations to collect, organize, and develop the base period benefit and non-benefit data used in the Medicare bid submissions.
+ Manage data input process to ensure that all vendors are providing necessary inputs in appropriate formats.
+ Validate data by reconciling it to financial statements. Identify and explain differences between the processing and reporting required for the bids and required for the financial statements. Resolve discrepancies by capturing information from data source owners.
+ Allocate source data to the bid submission level as necessary.
+ In combination with data vendors, substantiate data development for auditors via reconciliations to audited material (ex: financial statements) and via responses to requests during bid and financial audits.
Audit Support
+ Develop responses to bid desk review, bid audit, and financial audit questions.
+ Lead actuary owns responses related to Part B pharmacy projection and Part D bid base period development.
+ Coordinates with data suppliers and compliance to develop detailed responses to audit requests.
The Actuary, Analytics/Forecasting ensures data integrity by developing and executing necessary processes and controls around the flow of data. Collaborates with stakeholders to understand business needs/issues, troubleshoots problems, conducts root cause analysis, and develops cost effective resolutions for data anomalies. Advises executives to develop functional strategies (often segment specific) on matters of significance. Exercises independent judgment and decision making on complex issues regarding job duties and related tasks, and works under minimal supervision, Uses independent judgment requiring analysis of variable factors and determining the best course of action.
Use your skills to make an impact
Required Qualifications
+ Bachelor's Degree
+ FSA or ASA certifications
+ MAAA
+ Strong communication skills
+ Experience in more than two functions (e.g., modeling, pricing, rate filing, reporting & analysis, reserving or trending)
Preferred Qualifications
+ Medicare experience
+ Additional relevant professional designations.
Work-At-Home Requirements
To ensure Home or Hybrid Home/Office associates’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office associates must meet the following criteria:
+ At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested
+ Satellite, cellular and microwave connection can be used only if approved by leadership
+ Associates who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.
+ Humana will provide Home or Hybrid Home/Office associates with telephone equipment appropriate to meet the business requirements for their position/job.
+ Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information
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
