Vice President, Commercial Pricing & Forecasting

Who We Are

Point32Health is a leading health and wellbeing organization, delivering an ever-better personalized health care experience to everyone in our communities. At Point32Health, we are building on the quality, nonprofit heritage of our founding organizations, Tufts Health Plan and Harvard Pilgrim Health Care, where we leverage our experience and expertise to help people find their version of healthier living through a broad range of health plans and tools that make navigating health and wellbeing easier.

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

Job Summary

The Vice President of Commercial Pricing & Forecasting is responsible for pricing, filing and certifying rates, developing and maintaining rating methodologies, rate factor development, actuarial support for Underwriting, ensuring compliance with new and existing regulatory requirements and assessing our competitiveness in the markets we serve. In addition, responsible for development and maintenance of forecasting models, completion of the financial plan and the ongoing assessment of the financial performance of products and markets, impacting in excess of $4B in revenue. Responsible for prospective pricing and forecasting trends. Supports new product development initiatives, including expansion activities.

Key Responsibilities/Duties – what you will be doing

• Develop actuarially sound rates for all Commercial lines of business and markets
• Support underwriting methodology enhancements and new tool development
• Perform actuarial studies in support of Underwriting, including factor updates, rate structure changes, profitability analysis and segment performance
• Work with market teams on new product development, market positioning and competitive analysis
• Develop, maintain, and enhance forecasting models
• Responsible for forecast and plan development, including revenue, medical expense, pharmacy, pharmacy rebates, capitation, fixed medical, broker commission and other miscellaneous expense items for both the fully and self-insured segments
• Monitor actual to expected results and analyze drivers of variance
• Analyze historical trend and project future pricing trend
• Support regulatory reporting and compliance, e.g. CHIA premium reporting, Mental Health Parity
• Support business expansion efforts into new states and/or products
• Hire, onboard, engage and monitor performance of team members
• Other projects and duties as assigned.

Qualifications – what you need to perform the job

Certification and Licensure

• Fellow of the Society of Actuaries (FSA) or Associate of the Society of Actuaries (ASA) designation preferred

Education, Certification and Licensure

• Bachelor’s degree required.
• Master’s degree preferred.

Experience (minimum years required):

• Required (minimum): 10 years of progressively responsible experience in health care actuarial related functions, including pricing, underwriting, forecasting & product development.

Skill Requirements

• Ability to work in a matrix environment and maintain positive relationships across the organization
• Experience managing through change and complexity
• Ability to build and inspire teams
• Advanced critical thinking and problem solving ability
• Advanced proficiency in MS Office and software applications

Leadership Profile

Establishing a Competitive and Compelling Vision: Orchestrates a competitive and compelling mission with an aligned set of values, goals, and a winning strategic path. This vision ensures a forward-looking aspirational framework that guides current and future decisions and choices for an entire enterprise or business unit.

Managing an Effective and Agile Plan Execution: Establishes, manages, and monitors the operational tactical annual plan to effectively accomplish the mission, vision, values, and strategy.

Creating and Cultivating Culture: Formulates, communicates, and lives the culture and tone of the organization through highlightin