Accountabilities

Lead actuarial strategy and organizational development: Define and execute the strategic direction of the Medicare Advantage actuarial function. Lead, mentor, and develop a multidisciplinary team of actuaries and healthcare analytics professionals, overseeing recruitment, performance management, succession planning, resource allocation, budgets, and professional development.

Drive executive financial intelligence: Provide executive leadership and board-level reporting on plan financial performance, including medical loss ratios, claims trends, membership and revenue dynamics, member profitability, risk score performance, and regulatory revenue changes.

Oversee product strategy and pricing: Serve as the primary actuarial authority for Medicare Advantage product design and pricing. Partner with Product, Clinical, Pharmacy, Network, Finance, and Market Growth teams to evaluate benefit packages, supplemental benefits, formulary structures, cost-sharing arrangements, service-area expansion, and specialized plan offerings.

Manage valuation, reserving, and financial risk: Oversee actuarial valuation and financial reporting across plan offerings, including unpaid claim liabilities (IBNR), premium deficiency reserves, and risk-sharing settlements. Ensure compliance with statutory accounting principles, NAIC guidance, and CMS Medical Loss Ratio requirements.

Lead CMS bid strategy and submissions: Direct the end-to-end development, modeling, review, documentation, certification, and submission of annual Medicare Advantage Part C and Part D bids through the Health Plan Management System (HPMS). Maintain rigorous quality controls, assumption governance, scenario testing, and compliance with statutory deadlines and actuarial standards.

Interpret regulatory developments: Assess the financial implications of CMS Advance Notices, Final Rate Announcements, county benchmark changes, and risk adjustment model updates, including CMS-HCC model transitions. Align risk score forecasts and pricing assumptions with Risk Adjustment leadership.

Oversee regulatory settlements and financial guidance: Ensure actuarial financial statement items comply with applicable regulatory and accounting requirements, including Part D risk corridor reconciliations, low-income cost-sharing subsidies, federal reinsurance settlements, and Risk Adjustment Data Validation accruals.

Maintain governance and audit readiness: Establish and enforce actuarial policies, procedures, quality assurance standards, and internal controls. Ensure readiness for CMS financial examinations, RADV audits, and RAPS/EDPS encounter data reviews.

Advance actuarial methodologies and Star Ratings strategy: Introduce innovative analytical methods and continuous improvement initiatives. Partner with Quality and Stars Strategy leaders to quantify the financial impact of CMS Star Ratings, including Quality Bonus Payments and rebate percentages, and incorporate findings into long-term planning and bid strategies.

Strengthen cross-functional partnerships: Collaborate across departments to support strategic decisions, evaluate business opportunities, and align actuarial insights with value-based care objectives.

Develop actuarial talent and capabilities: Lead the actuarial development program, supporting exam preparation and professional credentialing toward ASA, FSA, and MAAA designations.

Deliver performance analytics: Provide pricing analyses, executive dashboards, and reporting on bid-to-actual variances, inpatient and outpatient unit costs, risk score trends, and program performance.

Requirements

Bachelor's degree in Actuarial Science, Mathematics, Statistics, Economics, or a related quantitative discipline.

Fellow of the Society of Actuaries (FSA) and Member of the American Academy of Actuaries (MAAA), in good standing, with the qualifications required to issue Statements of Actuarial Opinion and Medicare Advantage Part C and Part D actuarial certifications.

15+ years of health actuarial experience, including at least 7–10 years of senior leadership experience in Medicare Advantage bid preparation, Part C and Part D pricing, reserving, risk adjustment, and health plan financial management.

How Jobgether works

We use an AI-powered matching process to ensure your application is reviewed quickly, objectively, and fairly against the role's core requirements. Our system identifies the top-fitting candidates, and this shortlist is then shared directly with the hiring company. The final decision and next steps (interviews, assessments) are managed by their internal team.

We appreciate your interest and wish you the best!

Why Apply Through Jobgether?

Data Privacy Notice: By submitting your application, you acknowledge that Jobgether will process your personal data to evaluate your candidacy and share relevant information with the hiring employer. This processing is based on legitimate interest and pre-contractual measures under applicable data protection laws (including GDPR). You may exercise your rights (access, rectification, erasure, objection) at any time.

#LI-CL1