VP-Chief Actuary-Presbyterian Health Plan

Location Address

9521 San Mateo NE Albuquerque, NM 87113-2237

Summary

The Chief Actuary is the senior leader responsible for actuarial services, underwriting, pricing, reserving, forecasting, and insurance risk management. This role contributes to the financial soundness of the health plan, provides strategic insight to executive leadership, and oversees all actuarial and underwriting functions supporting government and commercial lines of business. The Chief Actuary serves as the Appointed Actuary and is accountable for regulatory compliance, actuarial governance, and the development of actuarial talent.

Job Description

Product and Pricing Strategy

• Evaluate and Promote Medicaid Rate Adequacy & State Partnership
• Oversee evaluation of capitation rate assumptions.
• Partner directly with the state Medicaid agency to ensure assumptions are reasonable, risk is managed, and rates are actuarially sound.
• Support rate negotiations and data submissions to the state and CMS.
• Analyze the impact of risk adjustment models, acuity shifts, redeterminations and eligibility churn, directed payments and supplemental payment programs, changes in