Job Description Summary
Plan, lead and perform highly effective and credible assigned actuarial and related activities under minimal direction. Enhance and protect the brand by contributing to effective Licensure and the Plan Performance Response Programs. Add strategic value to the Plans, BCBSA, and the Federal Employee Program (FEP) by providing actuarial and representation services. Contribute to influencing the political, legislative and regulatory arenas by effective actuarial analysis, appraisal of impact. and external representation. (To BCBSA management, Licensee management and external organizations, such as insurance regulators and the American Academy of Actuaries). Contribute to the effectiveness of the programs by providing credible and proficient technical advice, balanced by consideration of general business, state/federal insurance regulation, BCBSA licensure requirements and the competitive environment. The position requires a comprehensive recognition of Licensee functions and businesses (health insurance, managed care, other lines of insurance, third party administration, etc) in order to evaluate a Licensee's viability and competitive position and to review and critique the work of technical experts. Develop and maintain strong two-way communications on related technical and regulatory issues with Plan actuaries, Plan finance staff, and other areas of the Plans and Association as appropriate in order to ensure that positions and strategies are consistent with the long-term interests of Plans and of the Association.
Responsibilities include but are not limited to:
- Provide effective technical support and Plan actuarial interface/coordination to Association Office of Policy and Advocacy (OPA) legislative/regulatory activities and policy development. Effectively communicate legislative and regulatory developments and interpretations to Plan actuaries. Organize and lead Plan actuarial advisory groups as needed. Monitor state, National Association of Insurance Commissioner (NAIC) and federal actuarial and related financial activities having potential relevance to Plans and/or the Association. Credibly assess the implications on Plans, develop credible insights/recommendations, and effectively communicate to appropriate Plan and Association personnel. In coordination with OPA, Association management, Plan representatives, and, if appropriate, other trade associations, develop recommended positions on assigned actuarial issues. Develop and execute assigned response strategies to include authoring comment letters, delivering testimony at hearings and meetings, and representation (such as, at the NAIC Meetings or other forums). Develop and enhance the Association's reputation among Plans, regulators, and industry as a leader in health insurance financial and actuarial regulatory issues. In support of the above, effectively represent Blue Cross and Blue Shield system on American Academy of Actuaries and Society of Actuaries committees.
- Provide actuarial services in support of BCBSA's Federal Employee Program and Federal Employees Dental and Vision Plans (FEDVIP) to ensure the business objectives and the needs and expectations of FEP's management and governance, and Office of Personnel Managment (OPM) are met. Responsibilities include but are not limited to:
- Rate development, including trend analysis and forecasting, for FEP and FEDVIP products and any other related products, including negotiation with OPM;
- Development and management of multi-year forecast models for FEP and FEDVIP and relate d programs;
- Product development activities for FEP and FEDVIP, to include short-term and long-term development activities
- Competitive analysis of the FEHBP and FEDVIP and related markets;
- Development and management of IBNR models and financial reporting functions and requirements
- Strategic planning activities for FEP and FEDVIP and related programs
- In coordination with the BPFS Management Team
- Participate in the development and execution of BPFS outreach and educational activities, including but not limited to: National Finance, Actuarial & Underwriting Conference; Financial Training Program; constituency visits to Plan actuarial and financial staff.
- Provide technical support as needed for selected BPFS initiatives, including but not limited to: trend surveys and other actuarial studies; risk-based capital analyses and reporting; surveys on Plan practices; special projects for the PPFSC.
- Collaborate on trend analyses and industry developments.
- Provide technical expertise to, and respond to requests for technical assistance from Plan and Association staffs on a time permitting/priority basis.
- Support Licensure and the PPRP monitoring/review processes. Provide technical expertise as required. Participate in the monitoring of BCBSA licensees, evaluate total Plan pricing/financial risks, perform financial forecasts, and recommend solutions to performance problems, as required.
- Serves as a consultative resource for Plan and Association staff and represents the Association in professional activities relating to these areas. As a senior member of the Association's actuarial staff, the incumbent also participates in BPFS and/or interdivisional projects requiring actuarial expertise.
Required Education, Certifications and Experience
- Bachelors Degree Actuarial science, mathematics, accounting, business, or a related field
- Certification MAAA
- Progressive actuarial experience (operational, consulting, and/or regulatory) in the health insurance/ managed care industry.
- Comprehensive knowledge of the operational and regulatory processes applicable to the health insurance industry.
- Must have strong analytical and research skills, and the ability to integrate research results with pragmatic and operational considerations to arrive at reality-based conclusions.
- Demonstrated technical skills with the Microsoft Office Suite.
- The incumbent must possess significant initiative, independent judgment, a high degree of creativity, and the ability to take action in order to execute objectives in a timely and effective fashion.
- Excellent oral and written communication skills, as well as strong presentation skills in both formal and informal settings.
Preferred Education, Certifications and Experience
- Masters Degree
- Certification FSA
- Experience working in, consulting for or conducting regulatory oversight of Blue Cross Blue Shield Plans.
People Management - No