VP, Actuary job in Plantation

Plantation, Florida - FL Pediatric Associates

Job Ref:	13185
Employer:	Pediatric Associates
Sector:	Health Insurance
Qualifications:	Part Qualified Actuary Fully Qualified Actuary
Software:	Excel SQL R Python
Job Type:	Full Time
Salary and Benefits:	Competitive
Remote:	No
Location
Country:	United States
State/Province/County:	Florida - FL
City:	Plantation
Post Code:	33324
Map:	(Show on map)
Description
Pediatric Associates was founded in Hollywood, FL in 1955. The same clinician-led, evidence-based, medical home passion is a unifying driver for those who join Pediatric Associates Family of Companies. The Pediatric Associates Family of Companies is a growing team of Pediatricians and Pediatric Care Teammates who are excited to be part of the first nationwide Pediatric Primary Care Medical Home. We further our uniqueness by ensuring the clinician voice is leading our medical home innovations. Remote Opportunity PRIMARY FUNCTION The VP, Actuary, is responsible for building and leading the Actuarial department by providing actuarial services for existing and future value-based arrangements. The leader will oversee pricing for new contracts, IBNR reserves, and special projects. Provide valuation support by interpreting financial results and variances from forecast to help identify actions to assist in the risk management of the value-based care arrangements. ESSENTIAL DUTIES AND RESPONSIBILITIES This list may not include all the duties that may be assigned. Designs, reviews, and helps administer insurance, annuity, and pension plans by determining financial soundness and calculating premiums. Ascertains premium rates required and cash reserves and liabilities necessary to ensure payment of future benefits. Analyzes statistical information to estimate mortality, accident, sickness, disability, and retirement rates. Determines or helps determine company policy, and explains complex technical matters to company executives, government officials, shareholders, policyholders, and the public. Designs and completes special projects such as developing and maintaining experience-rating formulae and creating and/or reviewing alternative settlement formulate and risk sharing models. Responsible for recommendations on pricing, marketing, product design, claims, premium and enrollment administration of business unit. Identifies, evaluates, and responds to financial risks inherent in the pricing and development of value-based care services. Primary duties may include, but are not limited to: Prepares and interprets data and related formulae. Monitors trend of profit and profitability by line of business and/or product. Serves on major, multi-function projects as Actuarial representative. Organizes and directs the staffing and workflow of the section. Performs key actuarial functions including new product pricing, evaluation of the impact of new legislation, flexible benefit consulting, and special projects. Designs and completes special projects such as developing and maintaining experience-rating formulae and creating and/or reviewing alternative settlement formulate and risk sharing models. Responsible for recommendations on: Pricing, marketing, product design, claims, premium and enrollment administration of business unit. Responsible for valuation support for business unit by interpreting financial results, variances from forecast to help identify product and segment behavior to assist in the risk management of the business unit. Develops and maintains actuarial models to evaluate financial performance, risk and opportunities associated with value-cased care arrangements. Oversees the monthly IBNR process, ensuring timely and accurate estimation of surplus/deficits related to risk contracts. Collaborates with cross-functional teams, including accounting, FP&A, managed care, clinical, and operations to assess the impact of value-based care initiatives on overall business performance, to reconcile IBNR reserves with financial statements, and to provide insights into variances and trends. Provides analysis, guidance, and recommendations on contract negotiations strategies to optimize financial outcomes. Assess healthcare utilization patterns to identify trends, outliers, and opportunities for efficiency improvements. Employ predictive modeling techniques to forecast future healthcare costs, utilization patterns, and population health outcomes. Collaborates with clinical teams to anticipate financial risks, develop targeted interventions, and allocate resources to manage chronic conditions and prevent adverse health events. Leads the actuarial analysis and strategic planning for value-based care contracts including serving as subject matter expert on medical economics and IBNR-related matters, providing guidance and support to cross-functional teams and external partners as needed. Contributes to financial planning and forecasting by providing insights into long-term healthcare cost trends and revenue projections. Performs other duties as assigned. SUPERVISORY RESPONSIBILITIES Oversees management level personnels. QUALIFICATIONS EDUCATION: Requires a BA/BS degree. EXPERIENCE: Minimum of 6 years related experience; or any combination of education and experience, LICENSURE / CERTIFICATION ASA/FSA required from the Society of Actuaries (SOA). KNOWLEDGE, SKILLS, AND ABILITIES Strong mathematical skills, and a deep understanding of risk management. Excellent problem-solving skills. Ability to translate actuarial research into written recommendations. Strong proficiency in actuarial modeling software and statistical analysis tools (e.g. Excel, SQL, R, Python) In-depth understanding of medical economics principles, including healthcare cost analysis, reimbursement methodologies, risk stratification and financial performance metrics. Experience in conducting medical cost trend analysis, utilization review, and forecasting to support strategic decision-making. TYPICAL WORKING CONDITIONS Non-patient facing May be either full time remote/telework or rotate working in the office and remote/telework. If remote, this job must be U.S. based. OTHER PHYSICAL REQUIREMENTS Vision, Sense of sound, & Sense of touch Prolonged periods of sitting at a desk and working on a computer. Ability to lift 15 pounds at times. PERFORMANCE REQUIREMENTS Adhere to all organizational information security policies and protect all sensitive information including but not limited to ePHI and PHI (Protected Health Information) in accordance with organizational policy, Federal, State, and local regulations. The Pediatric Associates Family of Companies an Equal Employment Opportunity/Affirmative Action employers and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.