Director Actuarial Pricing

Profile

Description

The Director, Actuarial Pricing is responsible for setting pricing assumptions, submitting bids, filing and gaining approval of premium rates and rate certifications with regulatory agencies. Supports implementation of rates, new plans and benefit changes. Provides guidance to Product Development on new product/benefit cost impacts. Develops and maintains pricing tools that price standard and custom benefits. The Director, Actuarial Pricing requires an in-depth understanding of how organization capabilities interrelate across the function or segment.

Responsibilities

As the leader of PDP Pricing, Rx Assumptions & Analytics, the person in this role will combine elements of strategy, organizational ability, technical ability, and analytics to price, file, and forecast PDP, and to provide insights and collaboration to business leaders to help shape Humana Strategy.

This Director will lead a team of roughly 16 associates including four direct reports and will be responsible for the pricing, annual bid filing, and forecasting of PDP. This role will also interact with the business leaders to provide analytics and insights to shape business strategies. Responsibility includes developing numerous Part D assumptions, assuring the integrity of data and bid development, ensuring compliance with CMS requirements, and performing competitor analysis. The Director must be able to drive and manage multiple high-priority items simultaneously.

The Director will maintain strong relationships, interact, collaborate, and communicate with several stake-holders and partners in a matrixed organization, including the Compliance, the Chief Medicare Actuary, Product Development, Corporate Finance, Corporate Affairs, Formulary, Trade team, Pharmacy Network, external consulting actuaries, the PDP P/L owner, among others.

Decisions and recommendations to senior leaders are typically related to pricing and product strategy and on ensuring compliance with regulations and internal procedures and protocols, drives goals and objectives, and improves performance.

Required Qualifications


FSA or ASA plus relevant advanced degree, extensive work experience, and/or other relevant professional designations
8 or more years of technical experience
5 or more years of management experience
Demonstrated ability to work/lead under extreme time pressures and deadlines
Demonstrated leadership capability, has led sizable staff before
Experience in leading and developing other human capital leaders
Strong Communication Skills
Experience in more than three functions (e.g., modeling, pricing, rate filing, reporting & analysis, reserving or trending) and more than one product.
Must be passionate about contributing to an organization focused on continuously improving consumer experiences
Demonstrated collaboration skills and skilled at working as part of a team


Preferred Qualifications


Experience in a product line that has similar aspects to PDP (ie selection dynamics of an individual purchase/payment, risk adjustment, reinsurance, and risk corridors MAY be a substitute but Part D experience is strongly preferred.)
Visionary - embraces the big picture and translates into strategy; anticipates longer term business needs and prepares team to take on challenges
Effective Influencer
Talent mindset - integrates organization effectiveness, winning culture and human capital
Emotional intelligence
Presence - comfortable with senior leaders and other functional areas
Persuasive - effectively communicates trade-offs of business decisions and can sway an audience towards a course of action inclusive of external audiences and sharing business rationale


Scheduled Weekly Hours

40

About Us

Mission: At Humana, our cultural foundation is aligned to helping members achieve their best health by delivering personalized, simplified, whole-person healthcare experiences. Recognizing healthcare needs continue to evolve for each person, for each family and for each community, Humana continuously creates innovative solutions and resources that help people live their healthiest lives on their terms –when and where they need it. Our employees are at the heart of making this happen and that’s why we are dedicated to building an organization of dynamic talent whose experience and passion center on putting the customer first.

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