Senior 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 demonstrate Hello Heart's economic value.

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

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

• Offer strategic advice on healthcare economics, financial outcomes, pricing, and market opportunities.

• Lead studies on health economics, conduct cost savings analyses, and engage in outcomes research.

• Analyze 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 reserve requirements, and educate stakeholders.

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

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

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

• Assess the clinical and financial impacts of new products and services, providing actuarial input into strategic planning.

• Create executive-ready presentations, research materials, and publications.

• Monitor healthcare market dynamics, competitor trends, Medicare Advantage quality measures, and emerging reimbursement models.

⛳️ Requirements

• Over 10 years of actuarial experience in healthcare, health insurance, or a related healthcare organization, including health economic and financial analyses.

• Experience in client-facing roles or sales support, such as consulting or startup environments, with a proven track record of presenting analyses to customers, consultants, or executives.

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

• Proficiency in R programming.

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

• Proven ability to utilize artificial intelligence tools and agents for research, analysis, reporting, and complex workflows, while assessing outputs for accuracy and reliability.

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

• Credential as an Associate of the Society of Actuaries (ASA) or Fellow of the Society of Actuaries (FSA).

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

• Familiarity with risk adjustment, Medicare Advantage Star Ratings, healthcare quality metrics, and related audit processes.

• Strong written and verbal communication skills, including the ability to translate complex actuarial and statistical concepts into engaging presentations.

• Capability to influence cross-functional stakeholders, manage competing priorities, and independently drive high-impact initiatives in a fast-paced environment.

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

🏝️ Benefits

• Positive, diverse, and supportive organizational culture.

• Annual bonus included in compensation package.