Job Description

**Primary City/State:** Phoenix, Arizona **Department Name:** Actuarial-BHN Cntr **Work Shift:** Day **Job Category:** General Operations Help lead health care into the future. As one of the largest nonprofit health systems in the country, Banner Health has both the stability that comes with success and the values you can be proud to represent. If you're looking to leverage your abilities - you belong at Banner Health. Your pay and benefits are important components of your journey at Banner Health. This opportunity includes the option to participate in a variety of health, financial, and security benefits. In addition, this position may be eligible for our Management Incentive Program as part of your Total Rewards package. Banner Health Network (BHN) is an accountable care organization that joins Arizona's largest health care provider, Banner Health, and an extensive network of primary care and specialty physicians to provide the most comprehensive healthcare solutions for Maricopa County and parts of Pinal County. Through BHN, known nationally as an innovative leader in new health care models, insurance plans and physicians are coming together to work collaboratively to keep members in optimal health, while reducing costs. POSITION SUMMARY This position will report directly to the Banner Insurance Operations CFO and is responsible for overseeing all healthcare related actuarial and healthcare economics needs. This role will partner with other executives to establish the appropriate goals and strategies for the Banner Insurance Operations to be successful and achieve sustainable growth. This role will partner with the appropriate corporate organizations to coordinate rate filings and year-end financials. Is responsible for all pricing, rate development and filings for all products. This role will also be responsible for the strategic development of the actuarial and healthcare economic departments. Will lead the Actuarial team in reviewing trend forecasting and predictive modeling tools, defining underwriting policies to reduce selection price alternative plan designs and define product strategy, identifying strategies to reduce enterprise costs, reviewing reserves in support of audits of health care liabilities, communicating ROI for medical management and other health plan initiatives to leadership, preparing and delivering reports and presentations, analyzing, developing, and/or submitting Medicare Advantage and Prescription Drug plan bid pricing tools and/or plan benefit packages. This role will ensure the appropriate strategy is in place for analyzing and communicating data for Primary Care Physicians (PCPs), Specialists, and Hospital leadership. Will direct the preparation of rate filings to Centers for Medicare and Medicaid Services (CMS), Health and Human Services (HHS), Arizona's Medicaid agency and the State Department of Insurance (DOI). Represents Banner Health in public hearings concerning such matters as required. CORE FUNCTIONS 1. Directs, supervises, and evaluates the work of direct staff and matrixed employees. 2. Participates into the development of the department budget to meet corporate goals and objectives. Meets annual budgetary goals. Translates organizational plans, goals, and initiatives into assumptions for annual operating and/or capital budgets. Negotiates contracts with external vendors for products and/or services and monitors/evaluates quality and/or performance. 3. Directs and participates in the development, implementation, and consistent application of effective organizational policies, procedures, and practices. Develops and supports internal controls to ensure that assets are safeguarded, policies and operating procedures are followed, necessary controls are effective and efficient, and compliance with current laws and regulations is achieved. 4. Reviews, prepares, analyzes, and presents reports and recommendations to senior leadership regarding operations, programs, services, and/or other applicable areas of interest in order to provide concise and accurate information that aids in decision-making. MINIMUM QUALIFICATIONS Bachelor's Degree in applicable field of Statistics, Mathematics, Actuarial Science, Business, Finance, or Healthcare Administration. License/Certification: Fellowship of the Society of Actuaries (FSA) designation. Depending upon assigned area of responsibility, position may require applicable certifications and/or licensures, including but not limited to: RN; MD or DO; Driver's License; Certified Healthcare Protection Administrator (CHPA); Certified Protection Professional (CPP); Chartered Property Casualty Underwriter (CPCU); Associate in Risk Management (ARM); CPA; SPHR; Registered Health Information Administrator (RHIA); Registered Health Information Technologist (RHIT); Certified Healthcare Facility Manager (CHFM); Certified Facility Manager (CFM); Certified Coding Specialist (CCS); Certified Professional Coder (CPC); JD from an American Bar Association accredited school; admission to a State Bar Association. Requires experience in health actuarial services typically achieved with ten or more years of experience, including supervisory experience. Requires the ability to lead new business development activities, as well as annual business planning/execution and strategic planning as needed. Knowledge of health care and state government, familiarity with Medicaid, Commercial and Medicare related products. Demonstrated leadership capabilities, self-motivation, and a strong understanding of sales and relationship management. Excellent writing, communications and presentations skills are required. Strong analytical skills and ability to establish and maintain effective relationships with customers and gain their trust and respect. Seven or more years of MA-PD bid experience required. Knowledge of software for data analysis; specifically spreadsheets (e.g. MS Excel, VBA), data extraction and manipulation (e.g. SAS, Teradata, R) and data visualization (e.g. Tableau) **EEO Statement:** EEO/Disabled/Veterans ( Our organization supports a drug-free work environment. **Privacy Policy:** Privacy Policy ( EOE/Female/Minority/Disability/Veterans Banner Health supports a drug-free work environment. Banner Health complies with applicable federal and state laws and does not discriminate based on race, color, national origin, religion, sex, sexual orientation, gender identity or expression, age, or disability

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