Lead Actuary, Risk and Compliance

Employment Type: Full-time

Position Overview

Become a part of our caring community and help us put health first. The Lead Actuary, Risk and Compliance is responsible for the overall management and oversight of actuaries and/or support staff where activities are concerned with identifying and managing risks. Identifies and analyzes potential risks and estimates the potential financial consequences, develops and recommends controls and cost-effective approaches to minimize risks. The Actuary, Risk and Compliance works on problems of diverse scope and complexity ranging from moderate to substantial.

This Lead Actuary role within the Insurance Products Actuarial Compliance team is focused on the development of compliant bid inputs for Related Parties. In this role, you will have a unique opportunity to provide guidance and collaborate with business partners and leadership to inform strategy and ensure compliance on this complex and expanding area. In addition, this role supports the compliance of Medicare bid filings and allows you to see the overall end-to-end bid process at a leading Medicare Advantage organization. This is a great role for a collaborative individual who is detail-oriented and enjoys being part of a team that is at the center of a changing regulatory landscape.

The Lead Actuary, Risk and Compliance assesses and communicates information regarding actuarial/business risks across the organization. Provides peer review and counsel on a wide variety of company, industry, and regulatory practices. Activities may include monitoring and researching laws and regulations applicable to Medicare Advantage and actuarial science. Advises certifying actuaries, executives, and non-actuarial business partners, including Finance, on critical bid inputs for Related Parties. Exercises independent judgment and decision-making to determine the best course of action and recommends controls to mitigate risks.

In this specific role, you will be part of a team tasked with the assessment of risk, opportunities, and mitigation strategies to assure the compliant submission of bids to support pricing and product development of Medicare Advantage and Prescription Drug Plans that positively impact the financial performance of Humana.

Responsibilities

• Supporting Humana’s MA-PD bid filings by ensuring appropriate interpretation and implementation of CMS guidance, and implementation and execution of review standards and controls to minimize compliance risk associated with the bid filing.
• Participate in CMS audits and reviews related to Humana’s Medicare bids.
• Create and maintain process improvements to bid filings to continually improve Humana's ability to file compliant bids.
• Use your skills to make an impact.

Required Qualifications

• Bachelor's Degree
• 5 or more years of technical experience
• 2 or more years of project leadership experience
• Strong communication skills
• Associate or Fellow of the Society of Actuaries
• Member, American Academy of Actuaries

Preferred Qualifications

• Medicare Advantage experience
• Ability to manage large projects involving multiple actuarial and non-actuarial staff

Company Information

Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being.

Travel

While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.

Scheduled Weekly Hours

40

Pay Range

$129,300 - $177,800 per year

• The compensation range below reflects a good faith estimate of starting base pay for full-time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job-related skills, knowledge, experience, education, certifications, etc.
• This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.