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Health Care that Starts with You!
Join a truly mission-driven organization! Independent, nonprofit UCare is recognized as one of the Minnesota???s leading health plans. We provide more than 225,000 members across Minnesota and western Wisconsin with the health coverage plans and services they need to maintain and improve their health. The innovative coverage we create makes a difference for Medicare-eligible individuals, individuals and families enrolled in Minnesota Health Care Programs, such as MinnesotaCare and Medical Assistance, and disabled adults with special health care needs. UCare is growing in size, membership, products, geographic coverage, and employees. We???re an organization that???s going places. Be part of a team that cares about you, be part of UCare.
The Actuarial Manager will lead the UCare overall pricing strategies and certification requirements for Medicare, Medicaid, and the Health Insurance Exchange. Develop the projections for the Part C and Part D CMS bidding and DHS Competitive Bidding. Lead the annual EGWP premium rate setting process. Lead the health care exchange pricing and analysis to set benefit packages and premium levels. Assist in the analysis of new business opportunities. Specific duties and responsibilities include:
- Manage and coordinate the analysis, preparation, and filing of the Medicare premium rates and benefit package proposals for Part C. Develop and maintain a process to file Medicare premium rates under the Medicare Advantage bidding and Medicare Part D bidding process. Ensure thorough process documentation is maintained to meet CMS audit requirements. Work closely with the Financial and Reporting Manager to prepare data, projection factors, and required supporting information. Establish and maintain relationships with CMS staff as it relates to bidding and bid negotiation.
- Manage and coordinate the development of Federal filing of MSHO bid projections and filings ensuring consistency with state filings and Medicare coverage.
- Manage and coordinate the development and filing the health care exchange projections as required by federal and state regulation and other product pricing as needed.
- Collaborate with consulting actuarial firm to support the multiple bids submission requirements annually. Attain necessary regulatory certifications.
- Work closely with Managers and stakeholders from Government Programs, PMD, and Sales area to develop product pricing and federal bid filings.
- Maintain familiarity with competing product benefit packages and premium structure. Lead the development of pricing and benefit strategy for new and existing product lines. Provide supporting analysis for expansion proposals and other business opportunities.
- Manage and coordinate the process for setting employer group Medicare premium rates. Ensure pricing follows CMS group pricing guidelines. Work with Sales to develop pricing documents to be presented to employer groups.
- Coordinate with other Health Care Economics staff to obtain necessary information for pricing cycles.
- Serve as Health Care Economics representative on various ad-hoc work groups. Provide ad-hoc financial analysis as needed.
Actuarial Science, Mathematics, or Business Degree required. ASA Certification. Minimum 6 year’s related experience in Actuarial consulting or direct health insurance industry experience required. FSA certification or working towards the certification is preferred. Technical skills with SQL and/or SAS preferred.
At UCare, we welcome and employ a diverse employee group committed to meeting the needs of UCare, our members, and the communities we serve. EOE/AA
Enter a highly collaborative environment where people are truly engaged, and feedback is valued. You???ll enjoy a competitive salary and benefits, as well as a host of other perks, including a nationally recognized wellness program, and a bright, open, award-winning office space in Northeast Minneapolis???just minutes from major freeways and retail centers.
At UCare, we welcome and employ a diverse employee group committed to meeting the needs of UCare, our members, and the communities we serve.