Actuary, Risk and Compliance

Become a part of our caring community   The Lead Actuary, Risk and Compliance is responsible for the overall management and oversight of actuaries and/or support staff where activities are concerned with identifying and managing risks. You will identify and analyze potential risks and estimates the potential financial consequences, develop and recommend controls and cost-effective approaches to minimize risks. You will work on problems of diverse scope and complexity ranging from moderate to substantial. The Lead Actuary, Risk and Compliance will report to the Director, Actuarial Risk & Compliance. In this specific role, you will be part of a team tasked with assessment of risk, opportunities, and mitigation strategies to assure the compliant submission of bids to support Humana's pricing and product development of Medicare Advantage and Prescription Drug Plans that positively impact the financial performance of Humana. In particular, this position is responsible for ensuring compliance with CMS requirements related to Total Beneficiary Cost. This includes maintaining the internal version of the Out-of-Pocket Cost (OOPC) Model published by CMS, obtaining needed inputs from business partners, running and interpreting the model’s results, and partnering with the pricing actuaries to find solutions to resolving test failures. In addition, as a member of the Compliance team this role is responsible for: Supporting Humana’s MA-PD and PDP bid filings by ensuring appropriate interpretation and implementation of CMS guidance, and implementation and execution of review standards and controls to minimize compliance risk associated with the bid filing Participate in CMS audits and reviews related to Humana’s Medicare bids.  Create and maintain process improvements to bid filings to continually improve Humana's ability to file compliant bids. This position comes with the opportunity of leading a direct report. The Lead Actuary, Risk and Compliance assesses and communicates information regarding actuarial/business risks across the organization. You will provide peer review and counsel on a wide variety of company, industry, and regulatory practices. Activities may include monitoring developments in actuarial techniques, and researching laws and regulations applicable to actuarial science and insurance operations. You will advise executives to develop functional strategies (often segment specific) on matters of significance. Use your skills to make an impact   Required Qualifications 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) Demonstrated ability to articulate ideas effectively in both written and oral forms Preferred Qualifications Medicare Advantage experience Ability to manage large projects involving actuarial and non-actuarial staff Additional Information This is a remote position. Work at Home Requirements: To ensure Home or Hybrid Home/Office employees’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria: At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested. In certain roles, the minimum recommended internet speed required by Humana may not be sufficient for business needs. Humana reserves the right to require associates to upgrade their internet service if necessary. Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.   Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.   Scheduled Weekly Hours 40 Pay Range The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay