Company Statement

EmblemHealth is one of the nation’s largest not for profit health insurers, serving members across New York’s diverse communities with a full range of commercial and government-sponsored health plans for employers, individuals, and families. With a commitment to value-based care, EmblemHealth partners with top hospitals and doctors, including its own AdvantageCare Physicians, to deliver quality, affordable, convenient care. At over a dozen EmblemHealth Neighborhood Care locations, members and non-members alike have access to community-based health and wellness guidance and resources. For more information, visit emblemhealth.com.

Sr. Staff Actuary (Medicare)

🔍 New York, New York

Hot

💼: EmblemHealth

📅   : Mar 10, 2025 Post Date

Remote Position

Summary:

Provide the analytical resources necessary for the development of overall pricing and reserve setting strategies.
Lead projects to analyze current rate structures and develop improvements and alternatives.
Coordinate the actuarial staff as needed to support the activities of the affiliates.
Lead actuarial staff as needed to support the activities of the affiliates.

Responsibilities:

Work closely with Senior Product Management and Finance to analyze financial performance of blocks of business, including membership, trend, and financial analyses.
Work collaboratively with all areas of the organization to identify opportunities to improve product performance.
Oversee the development and filing of premium rates and/or expected costs with the appropriate regulatory authority (e.g., CMS, New York Department of Health).
Work closely with Risk Adjustment and other areas.
Advise and develop direct reports accountable for at least one line of business (e.g. ACA, Large Group, Medicare, Medicaid, SSP), as well as other staff.
Perform other duties as assigned or required.

Requirements:

A bachelor’s degree in actuarial science, mathematics, other physical science, or related finance/business degree
Associate of the Society of Actuaries (A.S.A.) required
Member of the American Academy of Actuaries (M.A.A.A.) required
Fellow of the Society of Actuaries (F.S.A.) preferred
10+ years of relevant, professional work experience and/or education required
6+ years of actuarial experience with ASA; or 5+ years’ experience with an FSA required
5+ years health insurance actuarial experience, preferably in the managed care industry required
1+ year of management experience required
Comprehensive understanding of actuarial principles and methodologies; strong mathematical and analytical skills required
Knowledge of reimbursement methodologies required
Ability to develop actionable reports for senior management required
Excellent written and oral communication skills to deliver complex information required
Proficiency with MS Office (Word, Excel, Access, PowerPoint, Outlook); data extraction, simulations, automation required

Security Disclosure

If you receive a job offer from EmblemHealth, the email will be from “HRTalentAcquisition” with the subject: “Offer of Employment for (job title) – Please respond online.” We will never ask you to join a Google Hangout, buy your own equipment, or pay to apply. We also do not use third-party email services like Yahoo or Gmail.

Pay Disclosure

At EmblemHealth, we prioritize transparency in our compensation practices. We provide a good faith estimate of the salary range for potential hires, which is based on key factors such as role responsibilities, candidate experience, education and training, internal equity, and market conditions. Please be aware that this estimate doesn’t account for geographic differences related to your work location. Typically, new hires may not start at the top of this range, as compensation is tailored to each individual's circumstances. For union positions, salaries will be determined according to the collective bargaining agreement. Join us at EmblemHealth, where your contributions are valued and supported by fair compensation.

EEOC Statement

We value the diverse backgrounds, perspectives, and experiences of our workforce. As an equal opportunity employer, we consider all qualified applicants for employment regardless of race, color, religion, sex, sexual orientation, gender identity, pregnancy, marital status, national origin, disability, veteran status, or any other protected characteristic protected by law.

Sponsorship Statement

EmblemHealth may provide work visa sponsorship depending on factors such as business unit requirements, position nature, costs, and applicable laws and regulations.