Senior Vice President – Health Plan Finance, Risk, and Health Management

Description
Who We Are
WPS Health Solutionsis 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 than75 years. Proud to be military and veteran ready.
Culture Drives Our Success
WPS 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. This results in people bringing their authentic selves to work every day in an organization that successfully adapts to business changes and new opportunities.
We are proud of the recognition we have received from local and national organization regarding our culture and workplace:WPS Newsroom – Awards and Recognition
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.
Essential Responsibilities
Leads the actuarial and underwriting functions, ensuring adherence to sound pricing and reserving practices – while serving as a thought partner in strategic pricing decisions, evaluating new products, and financial forecasting/budgeting.
Creates a network management function with the disciplines and data require to effectively manage and negotiate provider contracts.
Develops a compelling network strategy, ensuring a portfolio of best-fit networks to ensure a competitive value proposition in all geographies served.
Utilizes expertise in analyzing claims, membership, revenue, provider behavior, member behavior, and policy/benefit design to maximize medical expense opportunities for overall improvement with a focus on the identification of key trend drivers and cost variation.
Builds relationships with and presents information to segment leadership, clinical program leadership, and corporate actuarial and finance staff to help achieve financial growth objectives.
Develops new innovative measures and visualization techniques that consistently turn our data into actionable insights that increase the sophistication of our information.
Continue the momentum in rebuilding the companys clinical programs, strengthening these programs and closing capability gaps to manage risk and deliver value for our customers.
Mitigate pharmacy cost trend through contract negotiation and implementation of innovative models while ensuring value for our members, employees, and employer groups.
Launch an affordability of care discipline, including payment integrity, that ensures the highest degree of claims payment accuracy while continuously driving initiatives that minimize claims payment leakage.
Lead financial management, forecasting, and budgeting activities.
Provides ongoing management direction, feedback and coaching to staff on vision, priorities, projects, and individual performance and developm