Actuary

Responsibilities

• Establish yourself as the go-to actuarial SME for the Commercial team by participating in finalist meetings with prospective health plans.
• Audit and refine current Business Case Analysis (BCA) framework to actuarial standards.
• Build relationships with stakeholders across Clinical Research, Finance, Customer Success, and Sales.
• Lead methodology negotiations with health plan actuarial teams, securing ROI validation frameworks.
• Model financial risk for "at-risk" contracts, establishing reserves and pricing structures.
• Deliver customized BCAs for high-priority prospects using claims data and benchmarks.
• Own actuarial strategy for value-based care transition, designing risk-transfer models and contracting terms.
• Standardize Enhanced Claims Data Analysis (CDA) process.
• Create and deliver educational content like "VBC 101" and "Actuarial Playbook".
• Represent at industry conferences.

Requirements

Basic Requirements

• Bachelor's degree and career Associate of the Society of Actuaries (ASA).
• 8-10+ years of experience in health insurance, specifically claims data analysis, pricing, and underwriting.
• Deep expertise in Medicare Advantage (MA), Fully Insured, and ASO financial models.
• Proven ability to translate complex actuarial concepts for non-technical audiences and influence senior stakeholders.

Preferred Requirements

• Fellow of the Society of Actuaries (FSA) and Member of the American Academy of Actuaries (MAAA).
• Direct experience with large payer organizations (e.g., Optum, UHG, Anthem, BCBS plans).
• Proficiency in financial modeling (Excel) and data analysis tools; familiarity with healthcare data warehouses (Databricks) and claims datasets.
• Experience with AI tools (e.g., Claude Code) or willingness to develop AI-assisted workflows.