Mgr, Actuarial Process & Operations

Horizon BCBSNJ employees must live in New Jersey, New York, Pennsylvania, Connecticut or DelawareJob Summary:This position would be responsible for the build and execution of recurring management processes for Actuarial Services. The Manager will work with functional leaders to gather input and identify process improvements in order to achieve organizational objectives, improve reporting and business insights, and generating presentation materials. This role would function as a project manager and oversee goals and priorities with key stakeholders. This manager will also be responsible for the oversight of the actuarial department's current data processes and managing data analysts responsible for the updates and maintenance of the current processes and databases. The manager will work with divisional and business unit leaders across the enterprise to facilitate and manage actuarial alignment activities for those departments.

• Direct and drive the Segment Management Process and partner with leaders across Actuarial, Marketing, Sales, Underwriting, and HNS to review and identify emerging business insights around member level P&L data and to collaboratively develop solutions to enhance the Pricing of our products.
• Analyze risks, establish contingency plans, and identify trigger events and responsibility for initiating mitigating action for current Actuarial processes.
• Build a robust, systemic process to help the business better understand and take action on key metrics (e.g. u/w margin, premium, competitor actions).
• Generate useful insights to assist the CBU and Actuarial in managing the business.
• Oversee current Actuarial processes within the Actuarial department. Help enhance processes where applicable and ensure the department's business partners understand the processes/operations.
• Responsible for the development and ongoing monitoring of operational reporting for the Executive Intelligence System (EIS) Dashboard.
• Own the development, production, and continued enhancement of the department's Monthly Operating Report and partners across the enterprise to report, track, and challenge Actuarial business metrics in order to meet our P&L objectives.
• Contribute to Product Governance working with Data Governance, Analytics, IT, and Product Development. Report out any updates/issues to the Actuarial Department.
• Manage, develop and train staff; develop and monitor goals; conduct annual performance reviews, and administers salaries for the staff.

• Minimum high school diploma or GED
• Prefer Bachelor's degree in the finance, accounting, business administration, actuarial, or related field preferred; Work experience in lieu of degree accepted.
• Master's degree a plus
• Requires a minimum of eight (8) years' experience in the health care industry.
• Requires a minimum of six (6) years of analytical/financial experience.
• Requires a minimum of three (3) years of prior Project Management experience, preferably in healthcare
• Requires a successful track record in leading cross functional teams in large, multifaceted initiatives across an organization.

• Must have foundational knowledge of Actuarial function, processes, and data
• Project plan development and monitoring
• Knowledge of data processing concepts and related applications including, but not limited to Microsoft Access, SAS and SQL preferred.
• Requires health insurance industry, including product and insurance, terminology as well as health plan operations.

• Requires excellent management, organizational and leadership skills.
• Requires excellent oral and written communication skills.
• Requires excellent problem solving and analytical skills.
• Requires excellent presentation skills.

• Comprehensive health benefits (Medical/Dental/Vision)
• Retirement Plans
• Generous PTO
• Incentive Plans
• Wellness Programs
• Paid Volunteer Time Off
• Tuition Reimbursement