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Fallon Health Director and Senior Actuary, Public Plans REMOTE - Growing Healthcare Organization !! in Worcester, Massachusetts


About Fallon Health

Founded in 1977, Fallon Health is a leading health care services organization that supports the diverse and changing needs of those we serve. In addition to offering innovative health insurance solutions and a variety of Medicaid and Medicare products, we excel in creating unique health care programs and services that provide coordinated, integrated care for seniors and individuals with complex health needs. Fallon has consistently ranked among the nation’s top health plans, and is accredited by the National Committee for Quality Assurance for its HMO, Medicare Advantage and Medicaid products. For more information, visit fallonhealth.org.

Brief summary of purpose:

The Public Plans team within the Actuarial Department provides support to Product and Executive Leadership to improve plan performance through profitability and membership growth.


The Actuary serving as Director & Sr. Actuary, Public Plans is responsible for providing actuarial support for the following products: Medicaid and Community Care.

Specific responsibilities will include:

  • Support regulatory filings and management decisions for these products, including but not limit to: financial reporting to MassHealth, settlements with ACO partners, preparing Merged Market rate filings and MLR filings, reviewing annual CSR submissions and reconciliations, and providing audit support for these products, as needed.

  • Effectively communicate strategic options and results to leadership

  • Work with Product Management to monitor experience and to develop and analyze strategies to maximize revenue and optimize financial results

  • Conduct actuarial studies, develop, recommend actions to senior leadership and assist in the implementation to improve plan performance program wide

  • Review actuarial assumptions, pricing methodologies and assist leadership in strategic and tactile decision making.

  • Work on negotiations and lobbying for important business/product changes.

  • Review actuarial assumptions, pricing methodologies and assist leadership in strategic and tactile decision making.

  • Work on negotiations and lobbying for important business/product changes.

  • Analyze competitive information from other departments within FCHP in order to keep apprised of local and industry trends

  • Assist and analyze competitive data to drive our business objectives

  • Stay informed of national and local trends regarding product and provider changes

  • Stay informed of federal and state legislative changes

This role requires good communication with Sr. Management as well as the Actuarial, Finance, Operations, Sales, Clinical and Product teams to understand and model the most relevant factors, highlight risks and opportunities that exist, recommend actions to Senior Leadership and assist in their implementation to improve plan performance – profitability and membership growth.

Staff management responsibilities include training and developing staff, reviewing their work, and monitoring adherence to department and actuarial standards for quality, accuracy, and collaboration.



B.A./B.S. degree, preferably in Mathematics, Finance, Economics, or related field




10+ years of responsible health plan actuarial experience, including at least 5 years of actuarial experience in valuation and forecasting.

The ideal candidate must possess:

  • Highly-developed oral and written communication skills

  • Ability to effectively present to highest level of company management

  • Ability to integrate across department functions and several business functions

  • Ability to effectively manage difficult group dynamics

  • Ability to work congenially and collaboratively with department staff and business partners

  • Ability to influence decisions at management and senior management levels

  • Ability to implement Actuarial department standards and processes

  • Ability to develop and lead the execution of business processes

  • Ability to translate corporate and department goals into specific initiatives

  • Ability to influence the development of future corporate and department goal setting

  • Ability to direct a broad set of business processes and initiatives with accountability quality and accuracy of results

Fallon Health provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.


Location US-MA-Worcester

Posted Date 1 month ago (10/21/2021 4:06 PM)

Job ID 6572

# Positions 1

Category Finance