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Network Performance Lead

Primary Location: Hartford, CT
Additional Locations: CT-Hartford
Health care costs continue to top most self-funded employers minds, and they are looking to partner with organizations that best help them manage their underlying health care trends. This position focuses heavily on how Aetna's underlying network costs compare to other health insurance carriers offering self-funded plan options. By working collaboratively within Aetna, you will be responsible for analyzing and communicating our assumed network competitiveness across the country; this will involve working with sales, underwriting, and actuarial leaders to ensure proper positioning and pricing of our products. This position also works externally with major consulting firms to identify and communicate methodology updates, network nuances, and influence industry benchmarking standards. You will manage/coach a multi-functional group of actuarial staff in support of department mission to protect Aetna’s financial integrity, lead/manage projects in support of strategic and operating plan goals, and anticipate and recognize matters that materially affect financial results and make sound, unbiased reports on these matters.

Fundamental Components:
- Management of Resources- Lead/manage all external benchmarking for network cost positioning to support network performance goals for strategic and operating plans. Influence/motivate resources within and outside of direct control to complete projects, update methodologies, and utilize network cost data with local market understanding. Exhibit innovative use of resources.
- Scope of Decision Making- Provide critical feedback internally and externally to drive appropriate network cost positioning across all products.
- Staffing/Personnel- Develop a high performing team, including responsibility for hiring and termination decisions. Perform all other supervisory responsibilities for unit, including job coaching, performance reviews, and compensation determinations. Ensure access to appropriate tools, resources and training.
- Aetna Way- Foster behavior that reflects Aetna’s values and is in accordance with the Aetna Way.

Product & Business Knowledge:
- Assumptions & Data Sources- Review assumptions developed by staff from a business perspective and be able to influence senior management to accept alternative recommendations. Integrate understanding of internal and external data sources for quantifying risks.
- Programs, Policies & Processes- Apply knowledge of corporate products, programs, processes and policies to resolve problems and issues.
- Regulatory Issues- Assure compliance with applicable regulations, laws and standards.

Risk Analysis & Management:
- Risk Assessment- Provide leadership in the negotiation and influencing of sound business decisions through adherence to established risk management principles.
- Pricing, Trend & Benefit Design- Partner with business owners in decision making process around pricing and trend.

Technical Proficiency: - Use of Technology
- Develop creative technical solutions to a variety of problems. Stay apprised of technical innovations as potential solutions for actuarial issues and concerns.
Communication, Collaboration & Consultation:
- Constituent Focus- Lead interdepartmental teams to shape process and policy. Represent Aetna on industry workgroups/SOA or Academy forums.
- Verbal & Written Communication- Address most complex business issues. Have direct interaction with internal and external constituents. Maintain accurate documentation and consult on training and user support for tools and processes.
- Interaction with Constituents- Promote an environment where collaboration is encouraged and rewarded.


Background Experience:
Bachelor's degree along with 7+ years related work experience.
Must be an ASA or FSA and a member of the American Academy of Actuaries able to sign required actuarial certifications.
Prior management experience
Strong communication skills
Excellent technicals skills

Additional Job Information:
This position is heavily focused on external network cost evaluation metrics including fee-for-service discounts and risk-adjusted PMPMs (total cost of care). It will require understanding the data that is provided to external consulting firms and how the data is utilized by those consulting firms for their client specific evaluations. You will support industry initiatives underway on the definition of the data provided, and discuss use across consulting firms. This role is critical as the industry continues to move away from fee-for-service and moves to value based care or performance networks.

Required Skills:
General Business - Communicating for Impact, General Business - Consulting for Solutions, General Business - Turning Data into Information

Desired Skills:
Leadership - Collaborating for Results, Leadership - Driving Change, Leadership - Engaging and Developing People

Functional Skills:
Actuarial - Financial actuarial analysis, Actuarial - Management: < 25 employees, Actuarial - Research, General Management - Data analysis & interpretation, General Management - Data tools: building & utilization

Technology Experience:
Database - Microsoft Access, Desktop Tool - Microsoft Outlook, Desktop Tool - Microsoft PowerPoint, Desktop Tool - TE Microsoft Excel

Potential Telework Position:

Percent of Travel Required:
0 - 10%

EEO Statement:
Aetna is an Equal Opportunity, Affirmative Action Employer

Benefit Eligibility:
Benefit eligibility may vary by position.

Candidate Privacy Information:
Aetna takes our candidate's data privacy seriously. At no time will any Aetna recruiter or employee request any financial or personal information (Social Security Number, Credit card information for direct deposit, etc.) from you via e-mail. Any requests for information will be discussed prior and will be conducted through a secure website provided by the recruiter. Should you be asked for such information, please notify us immediately.


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