Oversees the organization's actuarial function and underwriting department, leading actuarial and underwriting staff to support UPMC Health Plan goals. Responsible for product pricing, reserve development, financial projections, actuarial analysis of benefit and provider changes, and advising senior management on the financial impact of pricing, contract arrangements, and new business opportunities.
Oversees underwriting operations, including rating, rate approval, group implementation, underwriting guidelines, regulatory compliance, and departmental processes. Collaborates with Finance and Actuarial leadership to align underwriting practices with financial projections, develop rating models, improve submission processes, mentor staff, and conduct performance reviews as applicable.
Responsibilities
1. Lead the Actuarial and Underwriting Departments, including staff training, process development, quality oversight, and accountability for all departmental work products.
2. Oversee rating, risk evaluation, rate implementation, proposal content, and underwriting communication and reporting.
3. Ensure group insurance pricing supports profitability while retaining and growing membership.
4. Represent the Health Plan's underwriting perspective with internal leaders, clients, brokers, consultants, and client financial representatives.
5. Develop, update, and maintain pricing tools and underwriting guidelines for large and small group rating.
6. Conduct performance reviews and provide leadership, coaching, and supervision to assigned actuarial and underwriting teams.
7. Continuously improve how the Underwriting and Actuarial Departments supports Sales, Marketing, and Account Management.
8. Ensure compliance with applicable state, FEHB, and government filing requirements, including timely completion and submission of filings.
9. Support Sales and Account Management in developing market strategies by using competitor information to improve market penetration and pricing.
10. Perform rate development activities as needed to support departmental workload and maintain timely delivery of work.
*Performs in accordance with system-wide competencies/behaviors.
*Performs other duties as assigned.
Qualifications:
Educational and Knowledge Requirements
• Education: Bachelor's degree in mathematics, statistics, actuarial science, economics, or a related field required; advanced degree preferred.
• Experience: At least 10 years of progressively responsible actuarial experience in health insurance, managed care, or an equivalent combination of training, education, and experience.
• Preferred Background: Experience with both commercial and government health programs preferred.
• Leadership: 2-5 years of management experience required.
• Industry Knowledge: In-depth understanding of health insurance market dynamics.
• Skills: Excellent problem-solving, analytical, oral communication, written communication, and PC skills.
