Head Risk Adjustment Actuary

Position Summary:

The Head Actuary will lead actuarial strategy and operations for a fast-growing healthcare insurtech focused on Medicare Advantage risk adjustment. This executive role combines deep actuarial expertise with innovative thinking to drive pricing, forecasting, and risk management in a technology-driven environment. The ideal candidate will have strong leadership skills, a proven track record in Medicare Advantage actuarial work, and the ability to leverage advanced analytics and automation to optimize financial performance and compliance.

Key Responsibilities:

• Strategic Leadership:

  • Define and execute actuarial strategy for Medicare Advantage risk adjustment and related revenue optimization initiatives.
  • Partner with executive leadership to align actuarial functions with business objectives and growth plans.

• Risk Adjustment & Pricing:

  • Oversee development of pricing models, bid submissions, and revenue projections for Medicare Advantage products.
  • Ensure compliance with CMS guidelines and risk adjustment methodologies (HCC, RxHCC).

• Analytics & Innovation:

  • Drive adoption of advanced analytics, predictive modeling, and automation to improve accuracy and efficiency.
  • Collaborate with data science and engineering teams to integrate actuarial models into insurtech platforms.

• Financial Management:

  • Monitor financial performance, reserves, and risk exposure; provide actionable insights to leadership.
  • Develop strategies to mitigate risk and optimize profitability.

• Leadership & Team Development:

  • Build and mentor a high-performing actuarial team; foster a culture of innovation and accountability.
  • Serve as a thought leader on actuarial best practices and emerging trends in healthcare and insurtech.

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 pricing and risk adjustment.
  • Proven leadership experience in a health plan, consulting, or insurtech environment.

• Skills:

  • Expertise in CMS bid process, risk adjustment models, and regulatory compliance.
  • Strong proficiency in actuarial software and data analytics tools (SQL, R, Python).
  • Exceptional strategic thinking, communication, and stakeholder management skills.

Preferred Attributes:

• Experience in a technology-driven or startup environment.
• Familiarity with machine learning and automation in actuarial processes.
• Ability to thrive in a fast-paced, innovative setting.