Senior Actuary IV
A leading Health Insurer is seeking a highly skilled and experienced Senior Actuary to lead pricing strategy and rate filing initiatives. This role is critical in ensuring the financial soundness and market competitiveness of our offerings across commercial, Medicare, and Medicaid lines of business. The ideal candidate will bring deep actuarial expertise, regulatory knowledge, and strategic insight to support product development and compliance.
Key Responsibilities:
Pricing Strategy & Development:
- Lead the development of premium rates for individual, small group, and large group health insurance products.
- Collaborate with product, finance, and underwriting teams to align pricing strategies with business goals.
- Analyze claims experience, trend projections, and risk adjustment impacts to inform pricing decisions.
- Support the design and evaluation of benefit structures and cost-sharing arrangements.
Regulatory Rate Filings:
- Prepare and submit actuarial rate filings to state Departments of Insurance (DOIs) and CMS.
- Ensure compliance with all regulatory requirements, including ACA, Medicaid, and Medicare Advantage guidelines.
- Respond to regulatory inquiries and objections, providing clear and defensible actuarial justifications.
- Monitor changes in federal and state regulations that impact pricing and filing processes.
Actuarial Analysis & Reporting:
- Conduct actuarial modeling and scenario testing to evaluate financial performance and risk exposure.
- Develop and maintain pricing models and tools to support ongoing rate development.
- Present findings and recommendations to senior leadership and cross-functional stakeholders.
- Mentor junior actuarial staff and support their professional development.
Qualifications:
- ASA or FSA designation from the Society of Actuaries.
- Bachelor's degree in Actuarial Science, Mathematics, Statistics, or a related field.
- 5+ years of actuarial experience in health insurance, with a focus on pricing and rate filings.
- Strong knowledge of ACA, Medicare Advantage, and/or Medicaid managed care regulations.
- Proficiency in actuarial software (e.g., Excel, SQL, SAS, R, or Python).
- Excellent analytical, communication, and project management skills.
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