WPS Health Solutions
Senior Vice President – Health Plan Finance, Risk, and Health Management
WPS Health Solutions, Nevada, Iowa, United States, 50201
Senior Vice President – Health Plan Finance, Risk, and Health Management
Job Category:
Supervisory/ManagementRequisition Number:
SENIO005714Posted:
August 20, 2024Full-TimeLocations
Corp Center Building1717 W BroadwayMadison, WI 53713, USAWPS Health Solutions is a leading not-for-profit health insurer and federal government contractor headquartered in Wisconsin. WPS offers health insurance plans for individuals, families, seniors, and group health plans for small to large businesses. We process claims and provide customer support for beneficiaries of the Medicare program and manage benefits for millions of active-duty and retired military personnel across the U.S. and abroad. WPS Health Solutions has been making health care easier for the people we serve for more than 75 years. Proud to be military and veteran ready.Culture Drives Our SuccessWPS’ Culture is where the great work and innovations of our people are seen, fueled, and rewarded. We accomplish this by creating an inclusive and empowering employee experience. We recognize the benefits of Diversity, Equity, and Inclusion as an investment in our workforce—both current and future—to effectively seek, leverage, and include diverse perspectives that fuel agility and innovation on high-performing teams.The Senior Vice President is responsible for actuarial and underwriting, network management and strategy, product management, network strategy, clinical programs, pharmacy, affordability of care, financial management, and healthcare economics. This role will lead and drive pricing strategy and discipline, reserving in accordance with actuarial standards, healthcare reporting and analytics, ensuring health insurance products are compliant with regulatory filings, financial management across the health plan, and collaborating across the business to drive actions that mitigate claims cost.Leads the actuarial and underwriting functions, ensuring adherence to sound pricing and reserving practices.Creates a network management function with the disciplines and data to effectively manage and negotiate provider contracts.Develops a compelling network strategy, ensuring a portfolio of best-fit networks.Utilizes expertise in analyzing claims, membership, revenue, provider behavior, member behavior, and policy/benefit design to maximize medical expense opportunities.Builds relationships with and presents information to segment leadership, clinical program leadership, and corporate actuarial and finance staff.Develops new innovative measures and visualization techniques to turn data into actionable insights.Continue the momentum in rebuilding the company’s clinical programs.Mitigate pharmacy cost trend through contract negotiation and implementation of innovative models.Launch an affordability of care discipline, including payment integrity.Lead financial management, forecasting, and budgeting activities.Provides ongoing management direction, feedback, and coaching to staff.QualificationsBachelor’s degree or equivalent combination of education and experience; Major in Statistics, Mathematics, Actuarial Science, Health Care Management, Finance, Economics; or other related fields.10+ years experience in Healthcare Economics or similar experience.Experience working with healthcare data, both structured and unstructured.Deep business acumen and understanding of current issues and trends within the medical/commercial product space.Thorough understanding of product design with demonstrated product design experience.Demonstrated success in product development, monitoring, reporting, and quality improvement.Proven consumer/client centric mindset.Proven capabilities in strategic planning and large-scale project management.Demonstrated ability to develop innovative solutions through advanced problem-solving skills.Outstanding project and resource management skills.Education Level:
Bachelor's DegreePreferred Qualifications:
MBASalary Range:
$285,000-325,000The base pay offered for this position may vary within the posted range based on your job-related knowledge, skills, experience, and may fall outside of this range.Work Location:
We are a remote-first organization and offer remote work in the following approved states:Arizona, Colorado, Connecticut, Florida, Georgia, Illinois, Indiana, Iowa, Michigan, Minnesota, Missouri, Nebraska, Nevada, New Jersey, North Carolina, North Dakota, Ohio, South Carolina, South Dakota, Texas, Virginia, WisconsinRemote Work Requirements:High speed cable or fiber internetMinimum of 10 Mbps downstream and at least 1 Mbps upstream internet connectionPerformance merit increase opportunities401(k) with dollar-per-dollar match up to 6% of salary (100% vested immediately)Competitive paid time offHealth insurance, dental insurance, and telehealth services start DAY 1Employee Resource GroupsProfessional and Leadership Development ProgramsEqual Opportunity Employer/Protected Veterans/Individuals with Disabilities
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Job Category:
Supervisory/ManagementRequisition Number:
SENIO005714Posted:
August 20, 2024Full-TimeLocations
Corp Center Building1717 W BroadwayMadison, WI 53713, USAWPS Health Solutions is a leading not-for-profit health insurer and federal government contractor headquartered in Wisconsin. WPS offers health insurance plans for individuals, families, seniors, and group health plans for small to large businesses. We process claims and provide customer support for beneficiaries of the Medicare program and manage benefits for millions of active-duty and retired military personnel across the U.S. and abroad. WPS Health Solutions has been making health care easier for the people we serve for more than 75 years. Proud to be military and veteran ready.Culture Drives Our SuccessWPS’ Culture is where the great work and innovations of our people are seen, fueled, and rewarded. We accomplish this by creating an inclusive and empowering employee experience. We recognize the benefits of Diversity, Equity, and Inclusion as an investment in our workforce—both current and future—to effectively seek, leverage, and include diverse perspectives that fuel agility and innovation on high-performing teams.The Senior Vice President is responsible for actuarial and underwriting, network management and strategy, product management, network strategy, clinical programs, pharmacy, affordability of care, financial management, and healthcare economics. This role will lead and drive pricing strategy and discipline, reserving in accordance with actuarial standards, healthcare reporting and analytics, ensuring health insurance products are compliant with regulatory filings, financial management across the health plan, and collaborating across the business to drive actions that mitigate claims cost.Leads the actuarial and underwriting functions, ensuring adherence to sound pricing and reserving practices.Creates a network management function with the disciplines and data to effectively manage and negotiate provider contracts.Develops a compelling network strategy, ensuring a portfolio of best-fit networks.Utilizes expertise in analyzing claims, membership, revenue, provider behavior, member behavior, and policy/benefit design to maximize medical expense opportunities.Builds relationships with and presents information to segment leadership, clinical program leadership, and corporate actuarial and finance staff.Develops new innovative measures and visualization techniques to turn data into actionable insights.Continue the momentum in rebuilding the company’s clinical programs.Mitigate pharmacy cost trend through contract negotiation and implementation of innovative models.Launch an affordability of care discipline, including payment integrity.Lead financial management, forecasting, and budgeting activities.Provides ongoing management direction, feedback, and coaching to staff.QualificationsBachelor’s degree or equivalent combination of education and experience; Major in Statistics, Mathematics, Actuarial Science, Health Care Management, Finance, Economics; or other related fields.10+ years experience in Healthcare Economics or similar experience.Experience working with healthcare data, both structured and unstructured.Deep business acumen and understanding of current issues and trends within the medical/commercial product space.Thorough understanding of product design with demonstrated product design experience.Demonstrated success in product development, monitoring, reporting, and quality improvement.Proven consumer/client centric mindset.Proven capabilities in strategic planning and large-scale project management.Demonstrated ability to develop innovative solutions through advanced problem-solving skills.Outstanding project and resource management skills.Education Level:
Bachelor's DegreePreferred Qualifications:
MBASalary Range:
$285,000-325,000The base pay offered for this position may vary within the posted range based on your job-related knowledge, skills, experience, and may fall outside of this range.Work Location:
We are a remote-first organization and offer remote work in the following approved states:Arizona, Colorado, Connecticut, Florida, Georgia, Illinois, Indiana, Iowa, Michigan, Minnesota, Missouri, Nebraska, Nevada, New Jersey, North Carolina, North Dakota, Ohio, South Carolina, South Dakota, Texas, Virginia, WisconsinRemote Work Requirements:High speed cable or fiber internetMinimum of 10 Mbps downstream and at least 1 Mbps upstream internet connectionPerformance merit increase opportunities401(k) with dollar-per-dollar match up to 6% of salary (100% vested immediately)Competitive paid time offHealth insurance, dental insurance, and telehealth services start DAY 1Employee Resource GroupsProfessional and Leadership Development ProgramsEqual Opportunity Employer/Protected Veterans/Individuals with Disabilities
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