精算师，风险与合规
Actuary, Risk and Compliance
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高级精算师，风险与合规负责对与识别和管理风险相关的精算师和支持人员的全面管理和监督。您将识别和分析潜在风险并估算潜在财务后果，制定并推荐控制措施和成本效益高的方法以降低风险。您将处理范围广泛且复杂的各类问题，从一般到重大不等。高级精算师，风险与合规向精算风险与合规总监汇报。在此特定职位中，您将作为团队成员，负责评估风险、机会和缓解策略，以确保符合要求的投标提交，支持Humana的医疗保险优势和处方药计划的定价和产品开发，从而积极影响Humana的财务表现。特别是，该职位负责确保符合与总受益人成本相关的CMS要求。这包括维护CMS发布的自付费用（OOPC）模型的内部版本，从业务合作伙伴处获取所需输入，运行并解释模型结果，并与定价精算师合作解决测试失败的问题。
此外，作为合规团队成员，该职位还负责：
- 通过确保对CMS指导的适当解读和实施，以及审查标准和控制措施的实施和执行，支持Humana的MA-PD和PDP投标文件，以最小化与投标文件相关的合规风险
- 参与与Humana医保投标相关的CMS审计和审查
- 创建和维护投标文件的流程改进，以持续提升Humana提交合规投标的能力
该职位有机会领导直接下属。
高级精算师，风险与合规在组织内评估和传达有关精算/业务风险的信息。您将就公司、行业和监管实践的广泛问题提供同行评审和建议。活动可能包括监控精算技术的发展，并研究适用于精算科学和保险运营的法律和法规。您将就重要事项向高管提供建议，以制定功能性策略（通常是针对特定细分市场的）。
发挥您的技能，产生影响
查看英文原文
Become a part of our caring community
The Lead Actuary, Risk and Compliance is responsible for the overall management and oversight of actuaries and/or support staff where activities are concerned with identifying and managing risks. You will identify and analyze potential risks and estimates the potential financial consequences, develop and recommend controls and cost-effective approaches to minimize risks. You will work on problems of diverse scope and complexity ranging from moderate to substantial.The Lead Actuary, Risk and Compliance will report to the Director, Actuarial Risk & Compliance. In this specific role, you will be part of a team tasked with assessment of risk, opportunities, and mitigation strategies to assure the compliant submission of bids to support Humana's pricing and product development of Medicare Advantage and Prescription Drug Plans that positively impact the financial performance of Humana. In particular, this position is responsible for ensuring compliance with CMS requirements related to Total Beneficiary Cost. This includes maintaining the internal version of the Out-of-Pocket Cost (OOPC) Model published by CMS, obtaining needed inputs from business partners, running and interpreting the model’s results, and partnering with the pricing actuaries to find solutions to resolving test failures.
In addition, as a member of the Compliance team this role is responsible for:
- Supporting Humana’s MA-PD and PDP bid filings by ensuring appropriate interpretation and implementation of CMS guidance, and implementation and execution of review standards and controls to minimize compliance risk associated with the bid filing
- Participate in CMS audits and reviews related to Humana’s Medicare bids.
- Create and maintain process improvements to bid filings to continually improve Humana's ability to file compliant bids.
This position comes with the opportunity of leading a direct report.
The Lead Actuary, Risk and Compliance assesses and communicates information regarding actuarial/business risks across the organization. You will provide peer review and counsel on a wide variety of company, industry, and regulatory practices. Activities may include monitoring developments in actuarial techniques, and researching laws and regulations applicable to actuarial science and insurance operations. You will advise executives to develop functional strategies (often segment specific) on matters of significance.
Use your skills to make an impact
Required Qualifications
- Bachelor's degree
- 8 or more years of technical experience
- 2 or more years of project leadership experience
- Associate or Fellow in the Society of Actuaries (ASA or FSA)
- Member of the American Academy of Actuaries (MAAA)
- Demonstrated ability to articulate ideas effectively in both written and oral forms
Preferred Qualifications
- Medicare Advantage experience
- Ability to manage large projects involving actuarial and non-actuarial staff
Additional Information
This is a remote position.
Work at Home Requirements: To ensure Home or Hybrid Home/Office employees’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria: At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested. In certain roles, the minimum recommended internet speed required by Humana may not be sufficient for business needs. Humana reserves the right to require associates to upgrade their internet service if necessary. Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.Scheduled Weekly Hours
40Pay Range
The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.$129,300 - $177,800 per yearThis job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.Description of Benefits
Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.Application Deadline: 09-22-2026
About us
About Humana: Humana Inc. (NYSE: HUM) is a leading U.S. healthcare company. Through our Humana insurance services and our CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare and Medicaid, families, individuals, military service personnel, and communities at large. Learn more about what we offer at Humana.com and at CenterWell.com.
Equal Opportunity Employer
It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.
Originally posted on Himalayas