Join Martin's Point Health Care - an innovative, not-for-profit health care organization offering care and coverage to the people of Maine and beyond. As a joined force of "people caring for people," Martin's Point employees are on a mission to transform our health care system while creating a healthier community. Martin's Point employees enjoy an organizational culture of trust and respect, where our values - taking care of ourselves and others, continuous learning, helping each other, and having fun - are brought to life every day. Join us and find out for yourself why Martin's Point has been certified as a "Great Place to Work" since 2015.
This position provides a wide range of actuarial expertise and support to the company, including responsibility for the actuarial support of Medicare product bids, US Family Health Plan (USFHP) rate negotiations with the Department of Health Administration (DHA) representation with external actuaries and others, planning and performance monitoring, expertise, consultation, analysis and reporting surrounding medical expense. As a largely individual contributor, this position must function well in a matrix management environment.
Job Description
Key Outcomes:
- Support the annual Medicare Advantage and Prescription Drug (MA/PD) bid development by working with the business and consulting actuarial firm on product design, trend review, and supplemental benefit projections that align with corporate objectives for growth and profit margin.
- Has lead responsibility for preparation and presentation of annual business healthcare expense budget and forecasting.
- Designs and implements measurement and monitoring of key performance metrics to identify trends and variances from budget and enable corrective actions on a timely basis.
- Provide analysis and advice to support the US Family Health Plan (USFHP) annual rate negotiation.
- Lead analysis and calculation of incurred but not reported claims (IBNR).
- Prepare and analyze monthly estimates for Medicare Part D settlement estimates.
- Develop and maintain knowledge and expertise in regional and national managed health care trends and best practices, seeking opportunities to translate those to Martin’s Point.
- Manage the process for annual medical cost and utilization projections and forecasts, by coordinating resources, expertise and information in concert with the financial planning cycle.
- Provide expertise and consultation on a wide array of business functions including, but not limited to provider reimbursement, claims processing, benefit adjudication, and compliance
- Support senior management (Chiefs and VPs) with special projects and research, including compiling white papers on special topics, as needed.
- Collaborates with the business to ensure appropriate integration of workstreams and ultimate delivery on company strategies.
- Communicates and interacts effectively and professionally with co-workers, management, etc.
Education/Experience:
- Bachelor’s degree in actuarial science, math, statistics or a related field is required.
- 8+ years of progressive actuarial experience in a wide range of medical expense analyses, contracting in a managed care setting, preferably in commercial and government programs business.
- Experience developing and managing a wide array of financial arrangements is preferred.
Required License(s) and/or Certification(s):
- Associate of the Society of Actuaries and Member of the American Academy of Actuaries.
Skills/Knowledge/Competencies (Behaviors):
- Demonstrates an understanding of and alignment with Martin’s Point Values.
- Strong analytical skills.
- Demonstrated interpersonal, communications and team building skills.
- Strategic ability to see the big picture and connect dots across mathematical and financial relationships and across an organization.
- Proven ability to organize work, simultaneously work on many activities and projects and meet deadlines directly and through matrix management.
- Strong track record of building internal and external collaborative relationships.
- Broad understanding of managed care business and financial principals such as underwriting, medical management, physician reimbursement and risk management.
- Strong oral and written communication to support executive level briefings and presentations both internal and external to Martin’s Point.
Exclusion from Federal Programs:
- Employee may not at any time have been or be excluded from participation in any federally funded program, including Medicare and Medicaid. This is a condition of employment. Employee must immediately notify his/her manager or the Clinic’s Compliance Officer if he/she is threatened with exclusion or becomes excluded from any federally funded program.
This position is not eligible for immigration sponsorship.
We are an equal opportunity/affirmative action employer.
Do you have a question about careers at Martin’s Point Health Care? Contact us at: [email protected]
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What We Do
Martin’s Point Health Care is an innovative not-for-profit health care organization offering high-quality, affordable health care and coverage to the people of Maine and throughout New England.
Martin’s Point has seven health care centers in Maine and New Hampshire offering primary and specialty care to those with most major health insurance plans. Martin’s Point also administers two health insurance plans: Generations Advantage—with the only 5-Star Medicare Advantage plans in northern New England, and the US Family Health Plan for active duty military families and retirees throughout most of northern New England and New York.
We believe that understanding both the clinical and health plan administrative side gives us the insight we need to make meaningful improvements to the health care system. Martin’s Point is dedicated to creating a community of healthy people through authentic relationships and trust
