Director, Actuarial Services (Reserve)-Remote, Work From Home

We are UPMC, and we are changing health care for the better. With 96,000 employees, 40 hospitals, 800 doctors’ offices and outpatient sites, and a more than 4 million-member Insurance Services Division, we all have one mission: to provide Life Changing Medicine, every day. Whoever you are and whatever you’d like to do, UPMC has a place for you.

UPMC Health Plan’s growing Actuary department is seeking a Director, Actuary to ensure that the UPMC Health Plan Actuarial Department provides the following services to various in-house clients.

Responsibilities:

• Consultant within UPMC Health System; Act as an Actuarial Consultant within the UPMC Health System and perform various activities, Including IBNR calculations, Data Analysis.
• Ensure that the departmental work products meet the highest standards of quality.
• Reserving: Works with the financial reporting department to develop reserve amounts for IBNR claims, active claims and premium deficiency reserves on a regular or as-needed basis.
• Benefits and Product Development: To provide appropriate UPMC management personnel with actuarial valuations of the Impact of any proposed benefit changes or new product designs on an as-needed basis.
• Underwriting: Works closely with the underwriting department to: Provide pricing tools to enable underwriting personnel to produce accurate price quotes on request from Sales and Marketing staff in a timely basis, together with whatever appropriate supportive documents may be needed by sales staff to facilitate sales.
• Provider Relations/contracting: To provide reports for the purpose of evaluating and advising UPMC HP management on the financial impact of proposed provider agreements or changes to existing agreements on an as-needed basis.
• Manage Actuarial Department: Supervise Actuarial department and various entities within UPMC Health Plan as needed to ensure department goals and objectives are met.
• Pricing: To develop product pricing levels, factors and methods to ensure premium and revenue flow adequate to cover medical and administrative costs and profit margins for the various product lines consistent with corporate strategic goals. Also, to advise UPMC Health Plan senior management on the financial impact of any special pricing or contract arrangements which may affect health plan financial profitability.
• Work with the UPMC HP Appointed Actuary to ensure satisfactory filings of annual Statements of Actuarial Opinion and associated memoranda.
• Direct the development and assessment of underwriting methods and tools in order to enhance the ability of underwriting staff to accurately identity and quantify risk, and so produce price quotes which appropriately match premium to risk.
• Supervise Actuarial department personnel to ensure that departmental objective and goals are achieved in a timely manner
• Forecasting: To provide UPMC HP senior management with regular and ad hoc reports which communicate current and future near- and long-term projections of financial performance of the various health product lines in order to facilitate corporate decision and the development of corporate strategies and goals.
• Compliance: Ensure that all required statutory rate filings are submitted appropriately, and that all rates, factors and methods are in compliance with applicable state and federal regulations. Ascertain and comply with filing and actuarial requirements for participation in government-sponsored health plans as appropriate.
• Additional Business: Ability to learn new lines of business to help UPMC Health Systems to expand into different arenas such as Slop Loss Insurance or Workers Compensation.