Director, Actuarial Services

This position is responsible for leading actuarial work across the organization. Work includes but is not limited to value-based payment strategy and provider contracting, supporting the Medicaid and Medicare lines of business, IBNR and reserving recommendations, and supporting the cost and utilization efforts of the organization. Time is focused on business group oversight, as well as enterprise-wide engagement. Primary duties include technical and operational leadership, as well as resource, relationship, and people management. This position provides input into strategic plans for the broader organization. Essential Responsibilities Directs actuarial services across the organization in support of Medicaid, Medicare, and other populations. Leads the execution of strategic initiatives, plans, and goals for areas of oversight in alignment with organizational vision and goals. Leads in developing, evaluating, and maintaining the financial terms of value-based payment models for the organization to support delivery system transformation in partnership with internal and external teams. Advises leadership on ways to improve CareOregon’s strategic and financial positioning to support its current and future provider network and strategic partners. Provides Medicaid rate setting support through data analysis, policy review and strategy development. Provides oversight of Medicare Advantage bid process. Develops profitability analytics to support evaluation by provider group, condition and other indicators. Monitors risk adjustment applied to capitation revenue and leads effort to ensure population risk is appropriately represented in encounter data. Reviews and provides guidance on actuarial estimates of IBNR, PDR and other actuarially determined assets and liabilities. Leads in developing and maintaining cost and utilization analyses for the organization. Oversees and ensures the timely completion of required regulatory reporting. Engages and oversees the work of outside actuaries to support their work and ensure the company’s interests are represented. Experience and/or Education Required Minimum 10 years’ experience in actuarial services, finance, or analytics Work experience in health insurance, preferably Medicaid and Medicare Minimum Associate of the Society of Actuaries Preferred Bachelor’s Degree in Actuarial Science, Finance, Mathematics, Economics or related field Fellow of the Society of Actuaries Minimum 4 years’ experience in a supervisory position Experience with value-based provider contracting models Knowledge, Skills And Abilities Required Extensive knowledge of managed care and the Oregon Health Plan Knowledge of federal Medicare regulations and state Medicaid rules Understanding of hospital and practitioner reimbursement mechanisms Demonstrated depth of experience in building relationships with multiple entities, including providers and community stakeholders Skilled in strategic thinking and executing strategy effectively Ability to communicate effectively, both verbally and in writing We are an equal opportunity employer. CareOregon is an equal opportunity employer. The organization selects the best individual for the job based upon job related qualifications, regardless of race, color, religion, sexual orientation, national origin, gender, gender identity, genetic information, age, veteran status, ancestry, marital status or disability.

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