[Remote] Actuary, Risk and Compliance at Humana

San Antonio, Texas, United States

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Not SpecifiedCompensation

Senior (5 to 8 years), Expert & Leadership (9+ years)Experience Level

Full TimeJob Type

UnknownVisa

Healthcare, InsuranceIndustries

Requirements

Bachelor's degree
8 or more years of technical experience
2 or more years of project leadership experience
Associate or Fellow in the Society of Actuaries
Member of the American Academy of Actuaries
Strong communication skills
Must be passionate about contributing to an organization focused on continuously improving consumer experiences

Responsibilities

Overall management and oversight of actuaries and/or support staff in identifying and managing risks
Identify and analyze potential risks and estimate potential financial consequences
Develop and recommend controls and cost-effective approaches to minimize risks
Assess and communicate information regarding actuarial/business risks across the organization
Provide peer review and counsel on company, industry, and regulatory practices
Monitor developments in actuarial techniques and research laws and regulations applicable to actuarial science and insurance operations
Advise executives to develop functional strategies on matters of significance
Exercise independent judgment and decision making on complex issues with minimal supervision
Support Humana’s MA-PD and PDP bid filings by ensuring appropriate interpretation and implementation of CMS guidance
Implement and execute review standards and controls to minimize compliance risk associated with bid filing
Participate in CMS audits and reviews related to Humana’s Medicare bids
Create and maintain process improvements to bid filings to improve compliant bid filing capabilities
Lead a team of 2 direct reports

Skills

Key technologies and capabilities for this role

Actuarial ScienceRisk ManagementComplianceMedicare AdvantagePrescription Drug PlansCMS GuidanceBid FilingFinancial ModelingRegulatory ComplianceAudit ParticipationPricing StrategyProduct Development

Questions & Answers

Common questions about this position

What is the pay range for this Lead Actuary position?

The compensation range reflects a good faith estimate of starting pay, but the specific range is not provided in the job description.

Is this a remote position, and what's the travel requirement?

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

What are the required qualifications for this role?

Candidates need a Bachelor's degree, 8+ years of technical experience, 2+ years of project leadership experience, Associate or Fellow status in the Society of Actuaries, membership in the American Academy of Actuaries, strong communication skills, and passion for improving consumer experiences.

Does this role involve leading a team?

Yes, this position includes the opportunity of leading a team of 2 direct reports.

What makes a strong candidate for this Lead Actuary role?

Strong candidates will have Medicare Advantage experience, strong communication skills, and the ability to manage large projects involving actuarial and non-actuarial staff, in addition to meeting all required qualifications.

Humana

Health insurance provider for seniors and military

About Humana

Humana provides health and well-being services, focusing on Medicare Advantage plans for seniors, military personnel, and communities. Their plans include HMO, PPO, and PFFS options, designed to improve health outcomes through comprehensive and flexible coverage. Humana's revenue comes from government contracts and member premiums, and they aim to maintain high renewal rates by offering quality service and competitive benefits. The company stands out by fostering a culture of inclusivity and belonging among its employees, while also ensuring accessibility for all members, including offering free language interpreter services. Humana's goal is to deliver value to its members through an extensive provider network and innovative health solutions.

Louisville, KentuckyHeadquarters

1961Year Founded

IPOCompany Stage

Social Impact, HealthcareIndustries

10,001+Employees

Risks

Potential over-reliance on AI could disrupt operations if systems fail or are compromised.

Rising medical costs and tightening Medicare reimbursements may strain financial performance.

Leadership change with new CEO Jim Rechtin could lead to strategic disruptions.

Differentiation

Humana is a leader in Medicare Advantage plans, focusing on seniors and military personnel.

The company emphasizes inclusivity, offering free language interpreter services for accessibility.

Humana leverages AI and cloud technologies through a partnership with Google Cloud.

Upsides

Humana's investment in Healthpilot enhances digital enrollment for Medicare options.

The company is the first insurer to cover TMS therapy for adolescent depression.

Humana's focus on value-based care aims to improve outcomes for kidney disease patients.

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