Director, Actuarial Services

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

📋 Description

• Oversee customer settlement calculations for value-based contracts, reconciling actual outcomes against contractual objectives such as shared savings, shared risk, and total cost of care benchmarks.

• Assist in health plan and payer contract negotiations by conducting actuarial analyses of proposed terms, risk arrangements, benchmarks, and financial forecasts.

• Manage underwriting for new and renewing contracts, including pricing assessments, population and market risk evaluations, and actuarial assumptions for growth and expansion.

• Generate claims-based reports on cost, utilization, and quality metrics for both internal leadership and external clients.

• Conduct analyses of claims trends, identify cost and utilization factors, and convert findings into actionable insights for clinical, operational, and growth strategies.

• Ensure the actuarial soundness of financial forecasts, reserves, and risk evaluations for value-based and risk-bearing arrangements.

• Collaborate with Data & Analytics and Medical Economics to verify claims and utilization data.

• Represent Tuesday Health in technical discussions with payer-side actuaries and analytics teams.

• Develop and mentor actuarial and analytical skills, establishing consistent methodologies and documentation.

⛳️ Requirements

• Extensive actuarial experience in value-based care, alternative payment models, or other risk-bearing healthcare frameworks.

• Practical experience with claims-based underwriting, pricing, and risk assessment for provider organizations, payers, or risk-bearing entities.

• Proven experience leading or directly performing settlement calculations and financial reconciliations for value-based contracts.

• Background in supporting payer contract negotiations through actuarial and financial analysis.

• Strong skills in claims data analysis, including the ability to identify and elucidate cost and utilization trends.

• Bachelor's degree in actuarial science, mathematics, statistics, economics, or a related quantitative discipline.

• Excellent written and verbal communication skills, with the ability to convey actuarial findings to non-actuarial audiences.

• Preferred: Fellow (FSA) or Associate (ASA) designation from the Society of Actuaries and Member of the American Academy of Actuaries (MAAA).

• Preferred: Experience working with complex/high-acuity value-based populations.

• Preferred: Familiarity with CMS alternative payment models or Medicare Advantage risk-adjustment methodologies.

• Preferred: Experience using SQL or similar tools for handling large claims datasets.

• Preferred: Experience in managing or mentoring actuarial or analytical staff.

🏝️ Benefits

• Comprehensive benefits package including medical, dental, vision, and life insurance.

• Paid time off and holidays.

• Employer 401(k) match.

• Remote work with several onsite sessions throughout the year.

• Dynamic and inclusive team environment.

• Meaningful work that supports seriously ill individuals and their caregivers.