Community Health Choice, Inc. (Community) is a non-profit managed care organization (MCO), licensed by the Texas Department of Insurance. Through its network of more than 10,000 providers and 94 hospitals, Community serves over 400,000 Members with the following programs:
• Medicaid State of Texas Access Reform (STAR) program for low-income children and pregnant women
• Children’s Health Insurance Program (CHIP) for the children of low-income parents, which includes CHIP Perinatal benefits for unborn children of pregnant women who do not qualify for Medicaid STAR
• Health Insurance Marketplace Plans that offer individual health coverage that includes preventive care, emergency services, prescription drugs, and hospitalization available to all, regardless of pre-existing conditions.
• Community Health Choice (HMO D-SNP), a Medicare Advantage Dual Special Needs plan for people with both Medicare and Medicaid that combines Medicare Part A and Part B benefits, Medicare Part D prescription drug coverage, and Medicaid benefits with additional health benefits like dental, vision, transportation, and more.
Improving Members' experiences is at the heart of every Community position. We strive every day to make sure that our Members have access to the high-quality health care they need and deserve.
Community is accredited by URAC for its health plan operations. We offer care management programs for asthma, diabetes, and high-risk pregnancy. An affiliate of the Harris Health System (Harris Health), Community is financially self-sufficient and receives no financial support from Harris Health or from Harris County taxpayers.
Skills / Requirements
The Actuary Director will lead all Actuarial and Medical Economic Activities for Community Health Choice. The role will provide medical trend analysis and projections, as well as opine on risk adjustment, and IBNR. The Actuary Director will oversee rate development for Marketplace and other products as necessary and may in the future lead any additional underwriting activities. In addition, they will lead and manage relationships with actuary firms or related vendors.
Responsibilities will include risk evaluation and management in support of strategies for profitable enrollment growth. The expectations involve use of actuarial principles to ensure our pricing; underwriting, statistics, reserving, and forecasting consider all implications of our rates, utilization, contract terms, member mix, and operations to provide Community with comfortable view of our financial standing.
- Bachelor's degree in Actuarial Science, Mathematics, Statistics or Economics.
- ASA Certification. FSA, MAAA preferred.
- Seven years of actuarial work in a health insurance or health care consulting, or similar setting.
- Mandatory product experience includes: ACA pricing, familiarity with Medicare, Medicaid, and Commercial business.
- Two years in a leadership/supervisory role