Senior Director, Financial Operations and Actuarial Strategy - Emory Health Plan

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Description

Senior Director, Financial Operations and Actuarial Strategy owns the financial infrastructure, controls, and operational oversight that enables sound financial management of EHP's medical, pharmacy, and administrative costs.

KEY RESPONSIBILITIES:

• Responsible for building and sustaining the financial operating systems, reporting cadences, budget processes, vendor financial controls, and regulatory compliance frameworks that support EHP's growth, governance, and fiduciary obligations as a large self-funded health plan.
• Owns EHP's vendor financial management function.
• Manages and directs the execution of Third Party Administrator (TPA) and Pharmacy Benefits Manager (PBM) invoice reconciliation, payment accuracy controls, and payment integrity oversight.
• Oversees financial performance of key vendors with substantial annual administrative spend, tracking contract compliance, unit cost trends, and administrative fee performance against contractual terms.
• Leads contract financial review and interpretation across all vendor and provider agreements, flagging financial risk and ensuring alignment with budget assumptions.
• Supports the senior leadership in strategic TPA, PBM, and stop-loss carrier contract negotiations with accurate, current financial performance data.
• Owns EHP's regulatory compliance function in partnership with third-party compliance advisors and internal legal and compliance leadership.
• Maintains EHP's compliance program for applicable self-funded plan regulations, including ERISA, HIPAA, ACA, and the Consolidated Appropriations Act (CAA) transparency and Mental Health Parity requirements.
• Oversees preparation and timely submission of all required regulatory filings and any applicable state filings.
• Coordinates internal and external audit processes, maintains compliance documentation and internal controls, and builds toward direct regulatory expertise as EHP's compliance function matures.
• Serves as an informed financial partner to senior leadership on actuarial and complex financial matters, including incurred but not reported (IBNR) reserve management, claims lag analysis, and pharmacy rebate accounting.
• Develops and maintains EHP's IBNR reserve reporting and reconciliation process, validating lag assumptions and reserve estimates against the plan's reserve fund in partnership with external actuaries.
• Owns the accounting methodology for pharmacy rebate accruals, claims runout, and other complex reserve items.
• Participates in the annual rate-setting and pricing process, providing financial data inputs, grounding actuarial assumptions in operational and claims experience, and contributing informed financial judgment to the pricing analysis led by senior leadership.
• Provides financial data inputs for stop-loss program reporting and benefits design financial modeling.
• Manages and develops a team, and, as EHP scales, hires and directs additional staff to support reserve, compliance, and senior leadership modeling needs.
• Provides clear direction, professional development, and performance management for all direct reports.
• Performs related responsibilities as required.

MINIMUM QUALIFICATIONS:

• Bachelor's degree in accounting, finance, health administration, business administration, or a related field required and 9+ years of progressive experience in health plan finance, managed care finance, or related healthcare financial operations, with demonstrated depth in financial controls, reporting, and accounting.
• CPA or equivalent accounting credential strongly preferred.
• Master's degree in business administration, health administration, or a related field preferred.

NOTE: Tasks related to this position can be performed remotely with only occasional supported visits to an Emory University location. Emory reserves the right to change this status with notice to employee.

Additional Details

Emory is an equal opportunity employer, and qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, protected veteran status or other characteristics protected by state or federal law. Emory University does not discriminate in admissions, educational programs, or employment, including recruitment, hiring, promotions, transfers, discipline, terminations, wage and salary administration, benefits, and training. Students, faculty, and staff are assured of participation in university programs and in the use of facilities without such discrimination. Emory University complies with Section 503 of the Rehabilitation Act of 1973, the Vietnam Era Veteran's Readjustment Assistance Act, and applicable executive orders, federal and state regulations regarding nondiscrimination, equal opportunity, and affirmative action (for protected veterans and individuals with disabilities). Inquiries regarding this policy should be directed to the Emory University Department of Equity and Civil Rights Compliance, 201 Dowman Drive, Administration Building, Atlanta, GA 30322. Telephone: 404-727-9867 (V) | 404-712-2049 (TDD).Emory University is committed to ensuring equal access and providing reasonable accommodations to qualified individuals with disabilities upon request. To request this document in an alternate format or to seek a reasonable accommodation, please contact the Department of Accessibility Services at or call 404-727-9877 (Voice) | 404-712-2049 (TDD). We kindly ask that requests be made at least seven business days in advance to allow adequate time for coordination.

Originally posted on Himalayas