Head of Medicare Segment Finance

The Head of Medicare Segment Finance has overall responsibility for the financial results of their assigned business segment. This position serves as the segment finance lead and has overall responsibility for relevant financial analysis, reporting, accounting close support, forecasting, budgeting, and ad hoc analyses for running the segment. This position will be a close strategic partner to the Segment General Manager and be jointly accountable for the successful growth and profitability of the aligned segment.

This includes full oversight and accountability for the Segment P&L inclusive of membership, Revenue, Medical expense, Pharmacy expense, non-claims medical, and admin allocations for the segment.

Key Accountabilities Include:

• Collaborate with segment leadership team to drive forward business and financial strategies to strengthen the segment’s position in the market. Focus will include product, pricing, network, health management, sales, exchanges, and administrative efficiencies.
• Represent the needs and requirements of the segment to understand and influence decisions in the development of trend reporting, cost saving initiatives, operational and platform performance and administrative efficiencies.
• Own and lead the M  and Q  process for assigned segment. This may include updating or developing new materials to report on segment results, evaluate segment performance, provide insights on the segment business results, analyze and track opportunities for growth/profitability enhancement, and other ad hoc analysis/management reporting.
• Evaluate financial implications of key decisions and initiatives, including major purchases, acquisitions, outsourcing arrangements, new products, IT systems development, geographic expansion opportunities, proposed new partner alignments, etc.
• Own and lead forecasting, annual budgeting, and long-term plan development for segment financials. Regular forecasting and budgeting updates will be made throughout the year covering the entire P&L for the segment.
• Take the lead on segment specific projects. Examples of such projects could include CMS bid development and submission, new vendor implementations, geographic expansions and/or significant platform enhancements.
• Oversee day-to-day team responsibilities and prioritize work (may include direct and indirect staff).

To be successful, this individual will also partner closely with analytics, actuarial, markets, network, and other enterprise teams as needed to effectively manage, grow, and enhance profitability for existing business or expand our existing offerings/geographical reach. Some of the key bodies of work will include: strategic planning, product pricing, product financial performance, risk management strategies, product design support, bid analysis/support, growth strategy design & execution.

Qualifications:

• Bachelor’s degree in Finance, Accounting, Economics or related field; equivalent combination of education and related work experience will also be considered.
• 10+ years of relevant combined experience in finance, accounting and/or product development.
• 5+ years direct management experience.
• Experience in finance and/or strategy in healthcare, insurance or managed care.
• Direct experience and deep knowledge of Medicare insurance business.
• Experience in budgeting, forecasting and the development of complex financial models within complex business environments / industries.
• Knowledge of applicable state and federal laws, particularly new laws related to health care reform.

Skills and Abilities:

• Strong oral and written communication and presentation skills.
• Self-directed and can develop and lead a technical team if needed.
• Ability to analyze and interpret complex financial data.
• Strong project management skills.
• Strong drive for results and accountability.
• Ability to articulate vision and strategy.
• Creative problem-solving skills using innovative approaches.
• Effective handling multiple complex projects with a high degree of engagement.
• Demonstrated leadership and influencing skills with the ability to lead and drive change.
• Strong strategic planning skills.
• Demonstrated ability to build consensus across multiple…