Actuarial Director Risk and Compliance

Profile

Description

The Director, Actuarial 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 Director, Actuarial Risk and Compliance requires an in-depth understanding of how organization capabilities interrelate across the function or segment.

Responsibilities

The Director, Actuarial 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 developments in actuarial techniques, and researching laws and regulations applicable to actuarial science and insurance operations. Decisions are typically related to the implementation of new/updated programs or large-scale projects for the function and supporting technical/operational procedures and processes, and implements strategic plans, drives goals and objectives, and improves performance. Provides input into functions strategy.

In this role you will lead a team of actuarial associates in the assessment of risk, opportunities, and mitigating 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.


Provide regulatory guidance and training on new, updated, and existing regulations and laws related to Medicare Advantage.
Provide strategic consulting to partners within and outside of Senior Products Actuarial
Facilitate CMS audits and reviews related to Humana's Medicare bids, including remediation of CMS Bid Audit Findings
Coordinate internal and external audits, and drive audit issues to closure
Lead development of bid inputs for Related Parties and Non-benefit Expense
Create and maintain process improvements to bid filings to continually improve Humana's ability to file compliant bids.
Create and support cooperative working relationships, both within the company-at-large and with outside business partners


Required Qualifications


Bachelor's degree
ASA or FSA
Medicare Advantage experience strongly preferred


Preferred Qualifications


Master's Degree
10 years of technical experience
Leadership experience
CMS Audit Experience


Scheduled Weekly Hours

40

Company info

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