Actuary - Medicare
Medicare Actuary (Remote)
A major regional health plan is seeking a Medicare Actuary to support pricing, forecasting, and bid development across Medicare Advantage (MA), Part D, and EGWP products. This individual will play a key role in annual bid development, financial forecasting, experience analysis, and strategic decision-making related to Medicare products.
This is an excellent opportunity for an actuary who enjoys working in a hands-on environment and wants to have a direct impact on pricing strategy, product performance, and business results.
Key Responsibilities
Medicare Bid Development & Pricing
- Support the development of annual Medicare Advantage and Part D bids.
- Develop and maintain pricing assumptions, including trend, risk adjustment, administrative expenses, and margin targets.
- Analyze and model the financial impact of benefit and product design changes.
- Partner with cross-functional stakeholders to evaluate and price strategic initiatives.
- Monitor CMS guidance and industry developments to assess impacts on pricing and bid assumptions.
Forecasting & Financial Analysis
- Develop and maintain Medicare financial forecasts.
- Analyze key drivers of performance and communicate risks and opportunities to leadership.
- Evaluate variances against budget and projections and provide actionable recommendations.
- Support long-term planning and strategic decision-making through financial modeling and scenario analysis.
Experience Studies & Analytics
- Perform experience studies to support pricing and forecasting assumptions.
- Evaluate utilization, cost trends, risk scores, and membership performance.
- Develop insights to improve financial results and business strategy.
- Identify opportunities to enhance actuarial methodologies, processes, and reporting.
Qualifications
- Bachelor's degree in Actuarial Science, Mathematics, Statistics, Economics, Finance, or a related field.
- ASA designation
- 4-6+ years of health actuarial experience.
- Medicare Advantage experience highly preferred
- Strong analytical, modeling, and forecasting skills.
- Ability to communicate complex actuarial concepts to both technical and non-technical audiences.
- Proven ability to work collaboratively across actuarial, finance, product, and operational teams.
Preferred Experience
- Medicare Advantage bid development.
- Part D and/or EGWP pricing experience.
- Financial forecasting and experience studies.
- Risk adjustment and Medicare product analytics.
- Process improvement and automation initiatives.
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