VP, Medicare Advantage Chief Actuary

Accountabilities: Lead actuarial strategy and organizational development: Define and execute the strategic direction of the Medicare Advantage actuarial function. Lead, mentor, and develop a multidisciplinary team of actuaries and healthcare analytics professionals, overseeing recruitment, performance management, succession planning, resource allocation, budgets, and professional development. Drive executive financial intelligence: Provide executive leadership and board-level reporting on plan financial performance, including medical loss ratios, claims trends, membership and revenue dynamics, member profitability, risk score performance, and regulatory revenue changes. Oversee product strategy and pricing: Serve as the primary actuarial authority for Medicare Advantage product design and pricing. Partner with Product, Clinical, Pharmacy, Network, Finance, and Market Growth teams to evaluate benefit packages, supplemental benefits, formulary structures, cost-sharing arrangements, service-area expansion, and specialized plan offerings. Manage valuation, reserving, and financial risk: Oversee actuarial valuation and financial reporting across plan offerings, including unpaid claim liabilities (IBNR), premium deficiency reserves, and risk-sharing settlements. Ensure compliance with statutory accounting principles, NAIC guidance, and CMS Medical Loss Ratio requirements. Lead CMS bid strategy and submissions: Direct the end-to-end development, modeling, review, documentation, certification, and submission of annual Medicare Advantage Part C and Part D bids through the Health Plan Management System (HPMS). Maintain rigorous quality controls, assumption governance, scenario testing, and compliance with statutory deadlines and actuarial standards. Interpret regulatory developments: Assess the financial implications of CMS Advance Notices, Final Rate Announcements, county benchmark changes, and risk adjustment model updates, including CMS-HCC model transitions. Align risk score forecasts and pricing assumptions with Risk Adjustment leadership. Oversee regulatory settlements and financial guidance: Ensure actuarial financial statement items comply with applicable regulatory and accounting requirements, including Part D risk corridor reconciliations, low-income cost-sharing subsidies, federal reinsurance settlements, and Risk Adjustment Data Validation accruals. Maintain governance and audit readiness: Establish and enforce actuarial policies, procedures, quality assurance standards, and internal controls. Ensure readiness for CMS financial examinations, RADV audits, and RAPS/EDPS encounter data reviews. Advance actuarial methodologies and Star Ratings strategy: Introduce innovative analytical methods and continuous improvement initiatives. Partner with Quality and Stars Strategy leaders to quantify the financial impact of CMS Star Ratings, including Quality Bonus Payments and rebate percentages, and incorporate findings into long-term planning and bid strategies. Strengthen cross-functional partnerships: Collaborate across departments to support strategic decisions, evaluate business opportunities, and align actuarial insights with value-based care objectives. Develop actuarial talent and capabilities: Lead the actuarial development program, supporting exam preparation and professional credentialing toward ASA, FSA, and MAAA designations. Deliver performance analytics: Provide pricing analyses, executive dashboards, and reporting on bid-to-actual variances, inpatient and outpatient unit costs, risk score trends, and program performance. 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, with the qualifications required to issue Statements of Actuarial Opinion and Medicare Advantage Part C and Part D actuarial certifications. 15+ years of health actuarial experience, including at least 7–10 years of senior leadership experience in Medicare Advantage bid preparation, Part C and Part D pricing, reserving, risk adjustment, and health plan financial management. Significant executive leadership experience within a Medicare Advantage organization, HMO, or national managed care carrier, with direct exposure to executive leadership teams and governing boards. Expert knowledge of CMS bid mechanics, HPMS filings, CMS-HCC and RxHCC risk adjustment models, Part D subsidy and formulary economics, Star Ratings financial mechanics, and statutory IBNR reserving. Deep understanding of healthcare financial, actuarial, and accounting principles, particularly value-based care delivery, capitation, two-sided risk arrangements, and Medicare Advantage statutory balance sheet management. Proven ability to lead, coach, mentor, and develop cross-functional teams of credentialed actuaries, actuarial students, and healthcare economics analysts. Extensive experience developing pricing strategies and financial plans for new products and specialized Medicare Advantage offerings, including Chronic Condition and Dual-Eligible Special Needs Plans (C-SNPs and D-SNPs). Ability to collaborate effectively across functions and organizational levels while delivering results under strict regulatory deadlines, particularly annual CMS bid submission timelines. Experience partnering with Sales and Growth teams to assess Annual Enrollment Period targets, geographic expansion opportunities, and competitive market positioning. Strong executive communication and presentation skills, with the ability to explain complex actuarial models, financial scenarios, and business trade-offs to senior leaders and board committees. Excellent organizational and prioritization skills, with the ability to manage competing demands during high-pressure bid cycles and regulatory filing periods. High professional integrity, sound judgment, and a commitment to ethical conduct and organizational values. Benefits: Annual base salary: $175,300–$249,100 USD. Performance incentives: Certain positions may qualify for performance-based incentives and/or equity, depending on role eligibility and individual and organizational performance. Healthcare coverage: Medical, dental, and vision insurance. Tax-advantaged savings: Flexible Spending Accounts (FSA) and Health Savings Accounts (HSA). Insurance protection: Life and disability insurance. Retirement savings: 401(k) plan with company match. Paid time off: Paid vacation, sick time, other paid leave, volunteer days, and wellness days. Employee support: Employee Assistance Program. Professional development: Learning and development opportunities. Additional perks: Employee resource groups, employee discount programs, and other benefits. Work arrangement: Remote/virtual position based in the United States.