Actuary Risk and Compliance

Profile

Job Information

Humana

Actuary, Risk and Compliance

in

Brentwood

Tennessee

Description

This Actuary role is a newly created 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.

Responsibilities

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.

Required Qualifications

Bachelor's Degree

FSA with at least 1 year of healthcare experience, or ASA with at least 3 years of healthcare experience

MAAA

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 judgement and thinking on complex issues

We will require full COVID vaccination (https://www.cdc.gov/coronavirus/2019-ncov/vaccines/fully-vaccinated.html#vaccinated) for this job as we are a healthcare company committed to putting health and safety first for our members, patients, associates and the communities we serve.

If progressed to offer, you will be required to provide proof of full vaccination or documentation for a medical or religious exemption consideration where allowed by law.

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

Additional Information

Interview Format:

As part of our hiring process for this opportunity, we will be using an exciting interviewing technology called Modern Hire to enhance our hiring and decision-making ability. Modern Hire allows us to quickly connect and gain valuable information for you pertaining to your relevant skills and experience at a time that is best for your schedule.

If you are selected for a first round interview, you will receive an email correspondence inviting you to participate in a Modern Hire interview. In this interview, you will listen to a set of interview questions over your phone and you will provide recorded responses to each question. You should anticipate this interview to take about 15 minutes. Your recorded interview will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews.

Alert:

Humana values personal identity protection. Please be aware that applicants selected for leader review may be asked to provide a social security number, if it is not already on file. When required, an email will be sent from Humana@myworkday.com with instructions to add the information into the application at Humana's secure website.

Scheduled Weekly Hours

40

Company info

Humana Inc.
Website : http://www.humana.com