Lead Actuary Risk and Compliance

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Job Information
Humana
Lead Actuary, Risk and Compliance
in
Boston
Massachusetts
Description
The Lead Actuary, Risk and Compliance is responsible for the overall management and oversight of actuaries and/or support staff where activities are concerned with identifying and managing risks. Identifies and analyzes potential risks and estimates the potential financial consequences, develops and recommends controls and cost-effective approaches to minimize risks. The Actuary, Risk and Compliance works on problems of diverse scope and complexity ranging from moderate to substantial.
This Lead Actuary role within the Senior Products Actuarial Compliance team is focused on development of compliant bid inputs for Related Parties and Non-benefit Expense (NBE). In this role, you will have a unique opportunity to provide guidance and collaborate with business partners and leadership to inform strategy and ensure compliance on these complex and expanding areas. In addition to involvement in Related Party and NBE, 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.
Responsibilities
The Lead Actuary, Risk and Compliance 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 may include monitoring and researching laws and regulations applicable to Medicare Advantage and actuarial science. Advises certifying actuaries, executives and non-actuarial business partners, including Finance, on critical bid inputs for Related Parties and Non-benefit Expense. Exercises independent judgment and decision making to determine the best course of action and recommends controls to mitigate risks.
In this specific role, you will be part of a team tasked with assessment of risk, opportunities, and mitigation strategies to assure the compliant submission of bids to support pricing and product development of Medicare Advantage and Prescription Drug Plans that positively impact the financial performance of Humana.
Supporting Humana's MA-PD 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.
Required Qualifications
Bachelor's degree
8 or more years of technical experience
2 or more years of project leadership experience
Associate or Fellow of the Society of Actuaries
Member, American Academy of Actuaries ​
Strong communication skills
Preferred Qualifications
Medicare Advantage experience
Ability to manage large projects involving multiple actuarial and non-actuarial staff
Additional Information
Scheduled Weekly Hours
40

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