Who We Are

Point32Health is a leading not-for-profit health and well-being organization dedicated to delivering high-quality, affordable healthcare. Serving nearly 2 million members, Point32Health builds on the legacy of Harvard Pilgrim Health Care and Tufts Health Plan to provide access to care and empower healthier lives for everyone. Our culture revolves around being a community of care and having shared values that guide our behaviors and decisions. We’ve had a long-standing commitment to inclusion and equal healthcare access and outcomes, regardless of background; it’s at the core of who we are. We value the rich mix of backgrounds, perspectives, and experiences of all of our colleagues, which helps us to provide service with empathy and better understand and meet the needs of the communities where we serve, live, and work. 

We enjoy the important work we do every day in service to our members, partners, colleagues and communities. Learn more about who we are at Point32Health.

Job Summary

The Director, Valuation and Stop Loss is responsible for determining and setting reserves across all lines of business for medical, pharmacy and stop-loss. They will determine the drivers of variances versus the financial plan at a product and state level, and partner with Operations, Health Care Services, Accounting, Provider Contracting, SIU, and other leaders as needed to assess the appropriateness of reserves each month. The Director in this role will also lead the reserving and financial management of Stop-Loss arrangements sold under the HPIC and TICO licenses, working closely with Health Plans, Inc, Medical Risk Managers (MRM), and preferred Stop Loss carriers to ensure reserves are adequate and that financial results are accurate. This includes meeting with management monthly and presenting emerging results and any reserving issues.

Job Description

Key Responsibilities/Duties – what you will be doing (top five):

Design and develop claims analysis methodologies, tools, and reports to identify and provide insight on the causes of reserve variances such as higher than budgeted claims, lower pharmacy rebates, and/or poor performance of certain rating/market segments.Create executive level reserve reports and present these reports to appropriate senior leadership committees on a monthly basis, including to the Chief Financial Officer. Communicate and implement analysis and forecast results to appropriate Underwriting, Pricing, FP&A, and AccountingTeams.Lead monthly joint Operations-Actuarial team and participate on cross-functional teams such as Health Care Services, Special Investigations Unit (SIU), Billing, Provider Contracting, and more.  Use these various inputs to set appropriate reserves each month.Lead the reserving and financial management of Stop-Loss arrangements sold under the HPIC and TICO licensesPartner with Health Plans, Inc, Medical Risk Managers (MRM), and preferred Stop Loss carriers to ensure reserves are adequate and that financial results are accurate.Present to management monthly on emerging Stop-Loss results and needed reserves, including reinsurance accruals.Special projects and other duties assigned by the Chief Actuary and/or CFO.Recruit, develop, motivate, assess, and reward staff. Coach and develop staff. Apply broad management expertise in planning, integrating and leading staff in implementation of programs or initiatives which are strategic.Oversee, develop and coach several actuarial students, supporting the Actuarial Student Program rotation process.Other projects and duties as assigned.

Qualifications – what you need to perform the job Education, Certification and Licensure

Bachelor’s degree or equivalent work experience required.Associate or Fellow of the Society of Actuaries

Experience (minimum years required):

10 plus years of relevant healthcare insurance work experience, including 5 or more in a management role.Pharmacy and Stop-Loss experience.Proven ability to improve processes, build new analytics, and optimize existing workflows.

Skill Requirements

Strong leadership and communication skills with ability to think strategically.Resilient, collaborative, flexible, innovative.Ability to function successfully in a changing environment with shifting priorities.

Working Conditions and Additional Requirements (include special requirements, e.g., lifting, travel):

Must be able to work under normal office conditions and work from home as required.Work may require simultaneous use of a telephone/headset and PC/keyboard and sitting for extended durations.May be required to work additional hours beyond standard work schedule.

Disclaimer

The above statements are intended to describe the general nature and level of work being performed by employees assigned to this classification. They are not intended to be construed as an exhaustive list of all responsibilities, duties and skills required of employees assigned to this position. Management retains the discretion to add to or change the duties of the position at any time.

Compensation & Total Rewards Overview

As part of our comprehensive total rewards program, colleagues are also eligible for variable pay. Eligibility for any bonus, commission, benefits, or any other form of compensation and benefits remains in the Company's sole discretion and may be modified at the Company’s sole discretion, consistent with the law.

Point32Health offers their Colleagues a competitive and comprehensive total rewards package which currently includes:

Medical, dental and vision coverage

Retirement plans

Paid time off

Employer-paid life and disability insurance with additional buy-up coverage options

Tuition program

Well-being benefits

Full suite of benefits to support career development, individual & family health, and financial health

For more details on our total rewards programs, visit https://www.point32health.org/careers/benefits/

We welcome all
All applicants are welcome and will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, disability, age, or veteran status.

Scam Alert: Point32Health has recently become aware of job posting scams where unauthorized individuals posing as Point32Health recruiters have placed job advertisements and reached out to potential candidates. These advertisements or individuals may ask the applicant to make a payment. Point32Health would never ask an applicant to make a payment related to a job application or job offer, or to pay for workplace equipment. If you have any concerns about the legitimacy of a job posting or recruiting contact, you may contact TA_operations@point32health.org