VP, Medicare Advantage – Chief Actuary

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

📋 Description

• Develop, implement, and steer the strategic direction for the Medicare Advantage actuarial function.

• Lead, coach, mentor, motivate, support, and cultivate a cross-functional actuarial and healthcare economics team.

• Oversee goal setting, career advancement, upskilling, resource allocation, staffing, budgeting, and succession planning.

• Deliver executive business intelligence regarding MLR, claims trends, membership and revenue dynamics, profitability, risk scores, and regulatory revenue shifts.

• Act as the primary actuarial authority for Medicare Advantage product strategy and pricing.

• Assess plan benefit packages, supplemental benefits, formularies, cost-sharing structures, service-area expansion, and specialized plan offerings.

• Supervise actuarial valuation, pricing, unpaid claim liabilities, IBNR, premium deficiency reserves, and risk-sharing settlements.

• Lead the comprehensive annual Medicare Advantage Part C and Part D bid development, modeling, certification, and HPMS submission.

• Manage assumptions, scenario testing, quality controls, executive review, and bid-to-actual monitoring.

• Analyze CMS policy and model the financial impacts of rate announcements, benchmark adjustments, and risk adjustment changes.

• Ensure compliance of actuarial financial statement items with CMS, actuarial, regulatory, and accounting standards.

• Maintain governance, quality assurance, compliance, and audit readiness for CMS examinations, RADV audits, and encounter data reviews.

• Innovate actuarial methodologies and integrate Star Ratings economics into strategic plans and bid curves.

• Foster cross-functional partnerships and align actuarial strategies with value-based care initiatives.

• Direct the company actuarial program and support the credentialing of junior and mid-level actuarial staff.

• Generate pricing analyses, reports, executive dashboards, bid-to-actual variance analyses, cost trends, and risk score tracking.

⛳️ Requirements

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

• Fellow of the Society of Actuaries (FSA) and Member of the American Academy of Actuaries (MAAA) in good standing.

• Meet qualification standards to issue Statements of Actuarial Opinion and CMS Medicare Advantage Part C and Part D Actuarial Certifications.

• 15+ years of health actuarial experience.

• A minimum of 7–10 years of direct, senior leadership experience in Medicare Advantage bid preparation, Part C/Part D pricing development, reserving, risk adjustment, and CMS health plan financial management.

• Significant executive leadership experience within a Medicare Advantage organization, HMO, or national managed care carrier.

• Direct interaction with executive leadership and governing boards.

• Expert knowledge of CMS bid mechanics, HPMS filings, CMS-HCC and RxHCC risk adjustment models, Part D direct subsidy/formulary economics, Star Ratings financial mechanics, and statutory IBNR reserving.

• Strong financial acumen and understanding of healthcare economics, actuarial and accounting practices, value-based care delivery, capitation, two-sided risk sharing, and Medicare Advantage statutory balance sheet management.

• Proven track record in developing, coaching, mentoring, and empowering cross-functional teams.

• Experience in formulating pricing strategies and plans for new products and innovative services, including specialized MA plans and supplemental benefit packages.

• Capability to collaborate across teams and organizational levels under strict statutory timelines.

• Experience in partnering with sales and growth teams on AEP targets, geographic service area expansions, and competitive positioning.

• Exceptional communication and negotiation skills, including the ability to present complex actuarial models and financial trade-offs to executives, plan leaders, and board committees.

• Ability to organize and prioritize workload during high-pressure bid cycles and regulatory filing periods.

• Commitment to working with integrity and upholding organizational values.

• Outstanding written and verbal communication skills.

• Authorized to work in the United States; visa sponsorship is not available.

🏝️ Benefits

• Medical, Vision, and Dental Plans.

• Tax-Advantage Savings Accounts (FSA & HSA).

• Life Insurance and Disability Insurance.

• Paid Time Off (PTO, Sick Time, Paid Leave, Volunteer & Wellness Days).

• Employee Assistance Program.

• 401k with company match.

• Employee Resource Groups.

• Employee Discount Program.

• Learning and Development Opportunities.

• Performance-based incentive and/or equity may be available depending on the position.

• Approved COVID-19 vaccination coverage/requirement for applicable member-facing roles.