Medicaid Pricing Actuary

San Antonio, Texas, United States

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Not SpecifiedCompensation

Expert & Leadership (9+ years)Experience Level

Full TimeJob Type

UnknownVisa

Health Insurance, HealthcareIndustries

Requirements

Candidates must possess a Bachelor's degree, FSA or ASA designation with relevant advanced degrees or professional designations, and MAAA certification. They should have strong technical and communication skills, experience in more than two actuarial functions, at least 8 years of technical experience, and 2 years of project leadership experience. Preferred qualifications include knowledge of Medicaid regulations and programs, experience with capitation rate development, and a detailed understanding of healthcare claims.

Responsibilities

The Medicaid Pricing Actuary will provide actuarial support for Medicaid product lines, including capitation rate review, drafting rate advocacy communications, actual-to-expected business analytics, and forecasting market-specific financial results. They will advise executives on functional strategies, exercise independent judgment on complex issues, and perform ad hoc market support.

Skills

Actuarial modeling

Pricing

Rate filing

Reporting

Analysis

Reserving

Trending

Medicaid regulations

Capitation rate development

Healthcare claims

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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