Product Pricing Manager: AvMed Health Plans

SCOPE OF POSITION:

This position is responsible for developing and implementing premium pricing methodologies for all AvMed products and business lines. This position oversees all of the financial, actuarial and competitor analysis activities necessary for the development of pricing strategies and tactical business decisions related to product pricing. Conduct analysis of premium rates and assist in the development of product pricing and premium rate filings to the Florida Office of Insurance Regulation (OIR) for all product lines. Work with key Company personnel to obtain cross-functional input to implement AvMed’s product pricing strategy and tactics, consistent with Underwriting, Marketing and overall Company goals and objectives. Oversee and participate in the pricing of existing and new products, benefits, and group-specific benefit designs. Provide routine reports and/or conduct studies for the purposes of monitoring adequacy of pricing factors and assumptions. Analyze product and segment performance, incorporating both historical observation and insight into prospective trends. Develop business plans containing forecasts of future financial performance. Manage and perform monthly analysis identifying opportunities to reduce medical cost and utilization and provide recommendations to senior management. Research, evaluate and analyze medical care cost trends by region, market segment and product line and conduct variance analysis with respect to utilization and unit costs.

Work with the Corporate Actuary in developing a standard collection of supplemental trend exhibits, examing items such demographics, product mix, contract mix, medical risk score, etc. Support the Corporate Actuary and Finance department personnel in assessing and evaluating the adequacy of Company claim liability reserves. Manage and develop AvMed’s annual Medicare product line bid submission to the Centers for Medicare and Medicaid Services (CMS).

QUALIFICATIONS:

A Bachelors degree from a four-year college or university is required. Certification as an

Associate of the Society of Actuaries is required. Active pursuit of Fellowship with the Society

of Actuaries is required. Minimum of five years of experience in data, statistical, actuarial,

financial analysis and/or underwriting in the health insurance setting. At least one year of

experience managing a team of associates and actuaries.

CRITICAL SKILLS/EXPERTISE:

Knowledge of Medicare bid processes and regulations. Knowledge of premium rate development methodologies and techniques in the health insurance setting. Experience in the development of statistical and financial models for pricing and risk management. Excellent analytical and problem solving skills. Strong organizational skills are needed in order to handle multiple tasks within time constraints. Ability to communicate effectively, orally and in writing, with all levels within the Company, community, regulatory agencies, customers and contracting agents. Ability to develop and maintain effective working relationships within and outside of the organization.

AvMed Health Plans is a Drug/Tobacco Free Workplace EOE