3527-Associate Vice President of Actuarial
Medicare AdvantageHealth OtherPricing & RatingReserving & ValuationExperience Studies
Role Summary
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Senior health actuarial leader (Director/AVP) responsible for pricing, reserving, risk adjustment, and forecasting for Medicare and value-based care products in the United States. Lead a team of actuarial analysts, build actuarial and financial models, and support CMS/CMMI regulatory filings and submissions. Requires extensive experience in health insurance actuarial work and strong technical skills in SQL, SAS, R, and Python.
JOB DESCRIPTION SUMMARY
- Lead pricing, reserving, risk-adjustment, and forecasting for Medicare/value-based products
- Develop and maintain actuarial and financial models to support pricing and forecasting
- Work with finance, underwriting, clinical, and analytics teams; present to executives
- Manage and mentor junior actuarial analysts and data modellers
- Use SQL, SAS, R, Python, Excel (VBA) and Tableau or Power BI
DOMAIN EXPERTISE
- CMS and CMMI program experience (Medicare, MSSP, ACO REACH)
- CMS risk adjustment modelling (HCC, RxHCC, CDPS)
- Health insurance pricing and value-based payment pricing
- Actuarial modelling for premium rate setting, reserving, forecasting
KEY REQUIREMENTS
- 10+ years actuarial, pricing, or financial analysis experience in health insurance/analytics
- FSA or ASA (or equivalent) preferred
- Strong experience with CMS, CMMI, Medicare programs (e.g., MA, MSSP, ACO REACH)
- Hands-on technical skills: SQL, SAS, R, Python, Excel (including VBA)
- Demonstrated people management and executive communication experience
TECH STACK
- Excel
- Tableau
- Power_BI
