Pricing Actuary – Medicare Advantage

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

📋 Description

• Lead and manage the comprehensive development, modeling, and submission of annual Medicare Advantage Part C and Part D bids.

• Ensure adherence to CMS guidelines and compliance with statutory deadlines.

• Collaborate with product, clinical, and local market leaders to create competitive benefit packages.

• Establish, justify, and document actuarial bid assumptions.

• Develop, enhance, and sustain scalable bid pricing models.

• Conduct scenario testing and sensitivity analyses in response to CMS payment policy changes, risk model updates, benchmark shifts, and competitive dynamics.

• Analyze CMS Call Letters, Bid Instructions, and Rate Announcements, translating alterations into modeling adjustments and executive recommendations.

• Work in conjunction with Finance, Healthcare Economics, Clinical Operations, and Network Management.

• Collaborate with data engineering and analytics teams to ensure the integrity of claims, enrollment, and risk adjustment data.

• Create executive-level presentations on bid strategy, financial outcomes, and risk profiles for leadership, board members, and regulatory reviewers.

⛳️ Requirements

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

• A minimum of 5 years of focused experience on Medicare Advantage bid pricing, plan design, and CMS bid submission.

• Proven ability to drive complex, time-sensitive projects to successful completion within established timelines.

• Advanced skills in actuarial modeling, claims data extraction, and financial modeling tools such as SQL, Python, R, SAS, or advanced Excel modeling.

• Comprehensive knowledge of Medicare Advantage pricing mechanisms, including Part D direct subsidy/benefit design, CMS risk adjustment models (CMS-HCC, RxHCC), impacts of Star Ratings on finances, and benchmark calculations.

• Outstanding interpersonal skills with a demonstrated history of effective cross-functional collaboration.

• Actuarial credentials such as ASA, FSA, or MAAA are desirable, though practical experience and a proven track record in bid leadership are equally valued.

• Experience interacting with reserving, underwriting, risk adjustment operations, or medical economics functions.

• Ability to thrive in a fast-paced, high-growth environment.

🏝️ Benefits

• Employer-sponsored health, dental, and vision plans with low or no premiums.

• Generous paid time off policy.

• $100 monthly stipend for mobile or internet expenses.

• Stock options available for all employees.

• Bonus eligibility for all positions below the Director level.

• Parental leave program offered.

• 401K retirement plan available.