Lead Medicaid Actuary (Manager)

San Antonio, Texas, United States

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Not SpecifiedCompensation

Expert & Leadership (9+ years)Experience Level

Full TimeJob Type

UnknownVisa

Health Insurance, Managed CareIndustries

Requirements

Candidates must possess FSA, MAAA or ASA, MAAA with a relevant advanced degree and a Bachelor's degree. A minimum of 8 years of relevant work experience is required, along with strong written and oral communication skills and the ability to manage multiple workstreams and prioritize competing interests. Preferred qualifications include 5 years of experience in the managed Medicaid industry, 3 years of project management experience, and in-depth knowledge of capitation rate development and its regulatory environment.

Responsibilities

The Lead Medicaid Actuary will provide actuarial, managerial, and business support for Medicaid product lines, serving as a project manager for complex issues. Responsibilities include capitation rate review, drafting rate advocacy communications, analyzing actual-to-expected business results, forecasting financial results, and conducting ad hoc analyses. The role involves advising leadership on rate advocacy and operational strategies, managing team timelines, balancing workloads, and developing team best practices for peer review and documentation.

Skills

Actuarial analysis

Capitation rate review

Rate advocacy

Financial forecasting

Risk analysis

Compliance

Operations analysis

Project management

Team management

Peer review

Documentation

Managed Medicaid

Regulatory environment

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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