Actuary, Risk and Compliance

🔥 12 hours ago

🇺🇸 United States – Remote

💵 $129.3k - $177.8k / year

⏰ Full Time

🟠 Senior

🔴 Lead

📊 Actuary

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

👻 Ghost score 0%

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Humana

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1961

🏥 Healthcare

🛡️ Insurance

⚕️ Healthcare Insurance

Healthcare • Insurance • Healthcare Insurance

Humana is a healthcare company dedicated to making a positive impact on the health of individuals, communities, and the healthcare system as a whole. With a focus on putting health first, Humana serves a diverse range of populations, including seniors and the military, providing Medicare Advantage HMO, PPO, and PFFS plans. Humana is committed to fostering a culture of belonging and mutual respect, offering competitive and flexible benefits to ensure the financial security of its employees and their families. The company prides itself on creating an inclusive workplace where everyone has the opportunity to succeed.

📋 Description

• Manage and oversee actuaries and/or support staff involved 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 risks, opportunities, and mitigation strategies for compliant Medicare Advantage and Prescription Drug Plan bids • Ensure compliance with CMS requirements related to Total Beneficiary Cost • Maintain Humana's internal version of the CMS Out-of-Pocket Cost Model • Obtain required inputs from business partners • Run and interpret the Out-of-Pocket Cost Model results • Partner with pricing actuaries to resolve test failures • Support MA-PD and PDP bid filings through interpretation and implementation of CMS guidance • Implement and execute review standards and controls to minimize bid-filing compliance risk • Participate in CMS audits and reviews related to Medicare bids • Create and maintain bid-filing process improvements • Assess and communicate actuarial and business risks across the organization • Provide peer review and counsel on company, industry, and regulatory practices • Monitor developments in actuarial techniques • Research laws and regulations applicable to actuarial science and insurance operations • Advise executives on significant functional strategies • Potentially lead one direct report

🎯 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 (ASA or FSA) • Member of the American Academy of Actuaries (MAAA) • Ability to articulate ideas effectively in written and oral forms • Medicare Advantage experience preferred • Ability to manage large projects involving actuarial and non-actuarial staff preferred • Ability to work from a dedicated space without ongoing interruptions to protect member PHI/HIPAA information • Self-provided internet service with at least 25 Mbps download and 10 Mbps upload speed

🏖️ Benefits

• Bonus incentive plan based upon company and/or individual performance • Medical benefits • Dental benefits • Vision benefits • 401(k) retirement savings plan • Paid time off • Company holidays • Personal holidays • Paid parental leave • Paid caregiver leave • Short-term disability • Long-term disability • Life insurance • Wellness and smart healthcare decision support • Occasional travel to Humana offices for training or meetings