The Actuary, Pricing MA-PD 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 Actuary, Pricing works on problems of diverse scope and complexity ranging from moderate to substantial.
The Actuary, Pricing establishes market level financial metrics to align with segment profitability goals, analyzes market level results and projections and develops recommended pricing actions to address gaps to targeted metrics. Leverages market level projections and experience data tools to research root cause and capture insights. Researches and understands competitors in marketplace and collaborates with sales and other partners supporting the markets to develop strategies for profitable membership growth. Accountable for actuarial certifications on rate filings, including attesting to compliance with state and federal rating and benefit regulations. Advises executives to develop functional strategies (often segment specific) on matters of significance. Exercises independent judgment and decision making on complex issues regarding job duties and related tasks, and works under minimal supervision, Uses independent judgment requiring analysis of variable factors and determining the best course of action.
- Directs the development of sound applications and models necessary to efficiently measure, monitor, and forecast the company's Part D revenue and claims
- Understands, explains, and projects Part D claims, including various components of Part D Costs
- Proactively identifies Prescription Drug expense trend opportunities and risks
- Assists in the development, documentation and submission of Part D Bids
- Prepares comprehensive documented observations, analyses and interpretations of results including technical reports, summaries and quantitative analyses.
- Requires communication and presentation skills, working independently with Humana Pharmacy Solutions, Senior Products Actuarial, and Finance on actuarial analyses and recommendations regarding appropriate courses of actions.
- Bachelor's Degree
- FSA or ASA plus relevant advanced degree, recent and relevant work experience, and/or other relevant professional designations.
- Demonstrated ability to present complex dynamics to market decision makers
- Experience in more than two functions (e.g., modeling, pricing, rate filing, reporting & analysis, reserving or trending)
Additional InformationInterview Format:
- Pharmacy Pricing, and/or Medicare experience a plus
- Healthcare Industry experience
As part of our hiring process for this opportunity, we will be using an exciting interviewing technology called Modern Hireto 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