Oscar Health - Senior Director, Actuarial - Risk Adjustment
Requirements
• Bachelor's degree in a STEM field, or 4 years commensurate experience. • 12+ years of quantitative analysis in the healthcare industry. • 5+ years of collaborating and influencing an Executive Leadership Committee. • Proven experience in a pricing role, or a related analytics-driven leadership role. • Strong government programs risk adjustment subject matter expertise, preferably in ACA Marketplace. • Extensive experience leading actuarial financial reporting, including claims reserving and risk adjustment. • Qualified (or willing to become qualified) to serve as appointed actuary for insurance companies the American Academy of Actuaries’ Specific qualification standard. • Excellent communication, collaboration, and relationship-building skills. • Strong process management skills, with experience streamlining workflows and driving operational efficiency. • Collaborative and influential leadership style, with experience partnering across multiple teams and stakeholders. • Strong familiarity with ACA-specific healthcare laws, regulations, and compliance requirements. • Fellow of the Society of Actuaries (SOA), or on the track to become one. • This is an authentic Oscar Health job opportunity.
Responsibilities
• ACA Risk Adjustment Financial Reporting & Forecasting: Lead financial reporting and forecasting for ACA risk adjustment, including monthly close, external audits, regulatory reviews, and other finance-related activities. • ACA Risk Adjustment Financial Reporting & Forecasting: • Oscar Risk Score Analysis & Projection: Develop strategic insights and projections regarding Oscar's ultimate risk scores and risk adjustment performance. • Oscar Risk Score Analysis & Projection: • Market Morbidity Analysis & Projection: Analyze market morbidity drivers and their financial implications, coordinating with key external stakeholders including industry consultants. • Market Morbidity Analysis & Projection: • Executive Advising & Reporting: Lead executive-facing reporting by managing key financial forecasts and delivering presentations that translate complex actuarial insights into actionable strategic recommendations for senior leadership. • Executive Advising & Reporting: • Cross-Functional Leadership: Build strategic partnerships across key business units (e.g., Finance, Risk Adjustment Operations, Market P&L) and represent the Actuarial function in executive forums. • Cross-Functional Leadership: • Advanced Analytics & Growth: Direct advanced analytics initiatives, leveraging key findings to shape enterprise-wide decision-making regarding pricing, strategic business growth, and network strategies. • Advanced Analytics & Growth: • Team Management & Development: Lead and develop a team of actuarial professionals, providing coaching, mentorship and professional development to foster continuous growth across the Actuarial team. • Team Management & Development: Lead and develop a team of actuarial professionals, providing coaching, mentorship and professional development to foster continuous growth across the Actuarial team • Other duties as assigned.
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