Tufts Health Plan
Vice President, Commercial Pricing & Forecasting
Tufts Health Plan, Canton, Massachusetts, us, 02021
Who We ArePoint32Health 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 SummaryThe 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 doingDevelop 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 jobCertification and LicensureFellow of the Society of Actuaries (FSA) or Associate of the Society of Actuaries (ASA) designation preferred.Education, Certification and LicensureBachelor’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 RequirementsAbility 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 ProfileEstablishing 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 highlighting mission and strategy aligned citizenship behaviors, standards, and norms.Optimizing Structure and Staffing : Attracts and selects staff and structures units, roles, and responsibilities; deploys aligned staff whose capabilities enable the organization to achieve its goals. Approaches decisions on talent utilization with both a tactical and strategic orientation.Marshalling and Optimizing Resources : Obtains and distributes all the hard and soft resources aligned to priorities, goals, and strategy; deploys the resources that best enable the organization to do their work today and to prepare for tomorrow.Monitoring and Appraising Results : Monitors and measures progress against plan; provides real-time supportive and corrective feedback and assistance.Representing and Responding to Stakeholders : Prepares and delivers presentations to and manages productive relationships with critical stakeholders; recognizes and responds to the diverse needs of key inside and outside stakeholders.Intervening In and Managing Conflict : Monitors and referees the normal and inevitable individual, team, and business unit conflicts; offers assistance and direction that moves to productive resolution. Utilizes productive conflict as a source of creativity, enhanced trust, and effective interpersonal problem solving.Investing In and Assuring Future Leadership:
Actively supports a vigorous talent management and succession process that provides a continuous flow of senior talent well into the future.Senior-Level Clinical Leadership in Related Industry Experience:
Experience in financial roles of increasing scope and responsibility; credibility earned from having served at least 20 years in executive finance positions in publicly traded or not-for-profit health organizations. Significant experience interacting with the board of directors and its audit committee and managing the organization’s relationship with banks and outside auditors.Compensation & Total Rewards OverviewAs part of our comprehensive total rewards program, colleagues are also eligible for variable pay. Eligibility for any bonus, commission, benefits, or any other form of compensation and benefits remains in the Company's sole discretion and may be modified at the Company’s sole discretion, consistent with the law.Point32Health offers their Colleagues a competitive and comprehensive total rewards package which currently includes:Medical, dental and vision coverage.Retirement plans.Paid time off.Employer-paid life and disability insurance with additional buy-up coverage options.Tuition program.Well-being benefits.Full suite of benefits to support career development, individual & family health, and financial health.For more details on our total rewards programs, visit
https://www.point32health.org/careers/benefits/ .Commitment to Diversity, Equity, Inclusion, Accessibility (DEIA) and Health EquityPoint32Health is committed to making diversity, equity, inclusion, accessibility and health equity part of everything we do—from product design to the workforce driving that innovation. Our Diversity, Equity, Inclusion, Accessibility (DEIA) and Health Equity team's strategy is deeply connected to our core values and will evolve as the changing nature of work shifts. Programming, events, and an inclusion infrastructure play a role in how we spread cultural awareness, train people leaders on engaging with their teams and provide parameters on how to recruit and retain talented and dynamic talent. We welcome all applicants and qualified individuals, who will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, disability, age, or veteran status.Scam Alert : Point32Health has recently become aware of job posting scams where unauthorized individuals posing as Point32Health recruiters have placed job advertisements and reached out to potential candidates. These advertisements or individuals may ask the applicant to make a payment. Point32Health would never ask an applicant to make a payment related to a job application or job offer, or to pay for workplace equipment. If you have any concerns about the legitimacy of a job posting or recruiting contact, you may contact
TA_operations@point32health.org .
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here .Job SummaryThe 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 doingDevelop 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 jobCertification and LicensureFellow of the Society of Actuaries (FSA) or Associate of the Society of Actuaries (ASA) designation preferred.Education, Certification and LicensureBachelor’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 RequirementsAbility 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 ProfileEstablishing 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 highlighting mission and strategy aligned citizenship behaviors, standards, and norms.Optimizing Structure and Staffing : Attracts and selects staff and structures units, roles, and responsibilities; deploys aligned staff whose capabilities enable the organization to achieve its goals. Approaches decisions on talent utilization with both a tactical and strategic orientation.Marshalling and Optimizing Resources : Obtains and distributes all the hard and soft resources aligned to priorities, goals, and strategy; deploys the resources that best enable the organization to do their work today and to prepare for tomorrow.Monitoring and Appraising Results : Monitors and measures progress against plan; provides real-time supportive and corrective feedback and assistance.Representing and Responding to Stakeholders : Prepares and delivers presentations to and manages productive relationships with critical stakeholders; recognizes and responds to the diverse needs of key inside and outside stakeholders.Intervening In and Managing Conflict : Monitors and referees the normal and inevitable individual, team, and business unit conflicts; offers assistance and direction that moves to productive resolution. Utilizes productive conflict as a source of creativity, enhanced trust, and effective interpersonal problem solving.Investing In and Assuring Future Leadership:
Actively supports a vigorous talent management and succession process that provides a continuous flow of senior talent well into the future.Senior-Level Clinical Leadership in Related Industry Experience:
Experience in financial roles of increasing scope and responsibility; credibility earned from having served at least 20 years in executive finance positions in publicly traded or not-for-profit health organizations. Significant experience interacting with the board of directors and its audit committee and managing the organization’s relationship with banks and outside auditors.Compensation & Total Rewards OverviewAs part of our comprehensive total rewards program, colleagues are also eligible for variable pay. Eligibility for any bonus, commission, benefits, or any other form of compensation and benefits remains in the Company's sole discretion and may be modified at the Company’s sole discretion, consistent with the law.Point32Health offers their Colleagues a competitive and comprehensive total rewards package which currently includes:Medical, dental and vision coverage.Retirement plans.Paid time off.Employer-paid life and disability insurance with additional buy-up coverage options.Tuition program.Well-being benefits.Full suite of benefits to support career development, individual & family health, and financial health.For more details on our total rewards programs, visit
https://www.point32health.org/careers/benefits/ .Commitment to Diversity, Equity, Inclusion, Accessibility (DEIA) and Health EquityPoint32Health is committed to making diversity, equity, inclusion, accessibility and health equity part of everything we do—from product design to the workforce driving that innovation. Our Diversity, Equity, Inclusion, Accessibility (DEIA) and Health Equity team's strategy is deeply connected to our core values and will evolve as the changing nature of work shifts. Programming, events, and an inclusion infrastructure play a role in how we spread cultural awareness, train people leaders on engaging with their teams and provide parameters on how to recruit and retain talented and dynamic talent. We welcome all applicants and qualified individuals, who will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, disability, age, or veteran status.Scam Alert : Point32Health has recently become aware of job posting scams where unauthorized individuals posing as Point32Health recruiters have placed job advertisements and reached out to potential candidates. These advertisements or individuals may ask the applicant to make a payment. Point32Health would never ask an applicant to make a payment related to a job application or job offer, or to pay for workplace equipment. If you have any concerns about the legitimacy of a job posting or recruiting contact, you may contact
TA_operations@point32health.org .
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