Director, Value Based Care Pricing Actuary

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

📋 Description

• Collaborate directly with underwriting leadership to assess and price Aggregate Excess of Loss opportunities.

• Evaluate provider risk arrangements related to Medicare Advantage, Commercial, Medicaid, and various value-based care programs.

• Analyze healthcare claims data, provider performance metrics, and financial risk-sharing frameworks.

• Create actuarial models and pricing strategies to facilitate informed underwriting decisions.

• Identify and assess new opportunities within value-based care markets.

• Offer insights into payer-provider dynamics, reimbursement frameworks, risk adjustment, and performance incentives.

• Assist in establishing underwriting standards and risk selection criteria for emerging market opportunities.

• Aid in portfolio management by tracking trends, profitability, and volatility across the business portfolio.

• Act as a trusted subject matter expert for carrier partners and internal stakeholders.

• Work together with leadership on strategic growth initiatives and opportunities for market expansion.

⛳️ Requirements

• ASA or FSA designation (or equivalent actuarial credentials) is required.

• A minimum of 7 years of actuarial experience in either a major health payer or a healthcare consulting firm with substantial value-based care exposure.

• Extensive knowledge of value-based care programs and provider risk arrangements.

• Strong grasp of healthcare claims analytics, risk adjustment, medical economics, and population health management.

• Experience in supporting Medicare Advantage, Commercial, Medicaid, ACO, MSSP, or similar risk-bearing initiatives.

• Advanced analytical and modeling skills are essential.

🏝️ Benefits

• Flexible remote work environment.

• Competitive compensation based on experience.

• Comprehensive benefits package, including medical, dental, vision, life and long-term disability insurance, and a 401(k) with company match.

• Generous paid time off (PTO) and sick leave.

• Opportunities for career advancement within a growing specialty insurance platform.