Head Staff Actuary
The Head Staff Actuary will lead actuarial strategy and operations for Medicare Advantage and Affordable Care Act (ACA) lines of business within the health plan. This role is responsible for pricing, forecasting, risk adjustment, and financial management to ensure compliance, profitability, and competitive positioning. The ideal candidate will combine deep actuarial expertise with strong leadership and analytical skills to drive innovation and support organizational growth.
Key Responsibilities:
Strategic Leadership:
- Develop and execute actuarial strategies for Medicare Advantage and ACA products, including pricing, bids, and risk adjustment.
- Partner with executive leadership to align actuarial functions with organizational goals and regulatory requirements.
Risk Adjustment & Revenue Optimization:
- Oversee modeling and forecasting for CMS risk adjustment programs (HCC, RxHCC) and ACA risk adjustment mechanisms.
- Monitor regulatory changes and ensure compliance with CMS and state guidelines.
Pricing & Financial Analysis:
- Lead development of premium rates, bid submissions, and actuarial assumptions for MA and ACA products.
- Analyze financial performance, reserves, and risk exposure; provide actionable insights to leadership.
Innovation & Analytics:
- Drive adoption of advanced analytics, predictive modeling, and automation in actuarial processes.
- Collaborate with data science and finance teams to enhance accuracy and efficiency.
Leadership & Team Development:
- Mentor and develop actuarial staff; foster a culture of innovation and continuous improvement.
- Serve as a thought leader on actuarial best practices and emerging trends in healthcare.
Qualifications:
Education:
- Bachelor's degree in Actuarial Science, Mathematics, Statistics, or related field; FSA designation required.
Experience:
- 10+ years of actuarial experience, with at least 5 years in Medicare Advantage and ACA pricing and risk adjustment.
- Proven leadership experience in a health plan or consulting environment.
Skills:
- Expertise in CMS bid process, ACA risk adjustment, and regulatory compliance.
- Strong proficiency in actuarial software and data analytics tools (Excel, SQL, R, Python).
- Excellent communication and stakeholder management skills.
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