Commercial Pricing Actuary

This is a fully remote position, open to applicants in United States.

📋 Description

• Lead the strategy, modeling, and financial execution for Commercial lines of business, encompassing Group and Self-Funded/ASO.

• Develop, enhance, and sustain scalable actuarial rating models and pricing engines for Commercial Large Group lines.

• Collaborate with product, clinical, and market leadership to create competitive benefit package pricing.

• Establish, justify, and document pricing assumptions, including manual rates, age/gender factors, area factors, trend projections, administrative expense allocations, and margin targets.

• Contribute to underwriting policy and risk selection strategies for group business.

• Provide actuarial oversight on intricate quote requests, experience rating formulas, and credibility logic.

• Design and maintain pricing methodologies for ASO products, employer-specific fee structures, and stop-loss/reinsurance coverage options.

• Monitor group risk profiles, employer group renewal performance, and dynamics of adverse selection.

• Oversee the preparation, documentation, and submission of annual and quarterly Commercial rate filings across various state departments of insurance and regulatory bodies.

• Act as the primary actuarial liaison with state regulators during rate review processes.

• Address regulatory objections, actuarial inquiries, and public feedback to secure rate approvals.

• Supervise ACA pricing mechanics, including HHS-HCC risk adjustment, MLR rebate calculations, state rate cap mandates, and the No Surprises Act.

• Collaborate with Finance, Healthcare Economics, Sales/Distribution, Network Management, and Clinical Operations.

• Prepare executive-level presentations regarding rate filing strategies, portfolio rate impacts, and margin projections.

⛳️ Requirements

• Over 8 years of progressive experience in healthcare actuarial roles.

• A minimum of 5 years with a direct focus on Commercial actuarial pricing, rating model development, and regulatory rate filings.

• Proven experience in building rating engines from the ground up or significantly enhancing pricing tools.

• Proficient in actuarial modeling and data manipulation, including SQL, Python, R, or SAS.

• Direct experience managing the complete lifecycle of Commercial rate filings through SERFF.

• Experience navigating state regulatory rate reviews and obtaining approvals in a timely manner.

• Hands-on experience in partnering with or setting guidelines for underwriting teams.

• Familiarity with rating logic and tracking portfolio performance.

• Proven ability to complete complex, time-sensitive filings and pricing projects on schedule.

• Excellent interpersonal skills and the ability to collaborate across functions.

• Capability to articulate complex actuarial concepts into clear strategic decisions for non-actuarial stakeholders.

• Actuarial designations are preferred but not mandatory: ASA or FSA and MAAA.

• Experience interacting with reserving, value-based contracting, or medical economics functions.

• Comfortable working in a fast-paced, high-growth environment.

• Formal degrees or certifications are not required; practical expertise and a proven track record will be acknowledged.

🏝️ Benefits

• Employer-sponsored health, dental, and vision plan with low or no premium.

• Generous paid time off.

• $100 monthly stipend for mobile or internet expenses.

• Stock options available for all employees.

• Bonus eligibility for all roles, except Director and above.

• Commission eligibility for Sales roles.

• Parental leave program.

• 401K program.