Director, Actuarial Services

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

📋 Description

• Collaborate with Sales, Consultant Relations, and Customer Success to enhance proposals and convey Hello Heart's economic value.

• Participate in client and consultant calls, performance reviews, and renewal discussions as a client-facing actuarial authority.

• Champion sound actuarial practices, suitable methodologies, and efficient analytical processes.

• Offer strategic insights on healthcare economics, financial outcomes, pricing, and market potentials.

• Lead health economic studies, cost savings analyses, and outcomes research initiatives.

• Examine medical claims, pharmacy claims, and other extensive datasets to assess utilization, medication adherence, costs, and financial outcomes.

• Create and sustain performance guarantee offerings, evaluate financial risks, manage reserves, and educate internal stakeholders.

• Formulate risk-based pricing strategies and support value-based contracting and specialty incentive initiatives.

• Present actuarial and health economic insights to customers, consultants, payers, industry audiences, and during conferences.

• Act as the primary actuarial contact for independent cost savings studies, research partnerships, and external analyses.

• Assess clinical and financial implications of new products and services, providing actuarial input for strategic planning.

• Craft executive-ready presentations, research documents, and publications.

• Monitor healthcare market trends, competitor movements, Medicare Advantage quality metrics, and emerging reimbursement models.

⛳️ Requirements

• Over 7 years of actuarial experience in healthcare, health insurance, or related healthcare organizations, including health economic and financial analyses.

• Experience in client-facing or sales-support roles, such as consulting or working in startups.

• Extensive knowledge of actuarial principles, healthcare economics, risk assessment, and statistical methods.

• Proficiency in R programming.

• Experience in analyzing large datasets of medical and pharmacy claims, including paid and allowed amounts, healthcare utilization, and medication adherence metrics.

• Capacity to utilize artificial intelligence tools and agents for research, analysis, reporting, and complex workflows, while ensuring output accuracy and reliability.

• Bachelor's degree in Mathematics, Statistics, Economics, Actuarial Science, or a related discipline.

• Associate of the Society of Actuaries (ASA) or Fellow of the Society of Actuaries (FSA) designation.

• Experience in developing or assessing healthcare cost savings studies, financial outcomes research, performance guarantees, and risk-based pricing models.

• Knowledge of risk adjustment, Medicare Advantage Star Ratings, healthcare quality metrics, and associated audit processes.

• Strong written and verbal communication abilities.

• Skill in influencing cross-functional stakeholders, managing competing priorities, and independently driving impactful initiatives.

• Willingness to travel up to 20% of the time.

🏝️ Benefits

• Annual salary and bonus compensation.

• Positive, diverse, and supportive workplace culture.

• Collaborative, creative, and bold work environment.