Accounting/Finance - Director Actuary 125-7000
Medicare AdvantageACA ExchangeCommercial Employer HealthPricing & RatingExperience StudiesReserving & Valuation
Role Summary
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Director-level health actuary based in Tulsa, OK focused on Medicare Advantage and ACA pricing, risk adjustment, and large-group pricing. You will lead an actuarial team, develop an internal actuarial function, coordinate filings and RADV work, and support reserving and trend analysis across the health plan.
JOB DESCRIPTION SUMMARY
- Lead actuarial function for Medicare Advantage and ACA risk adjustment
- Oversee pricing, bids, and large-group pricing model maintenance
- Coordinate rate filings and RADV reporting with external actuaries
- Provide oversight of IBNR, PDR and actuarial accrual development
- Based in Tulsa, OK — Director-level role requiring 8+ years in health
DOMAIN EXPERTISE
- Medicare Advantage pricing and bid process
- Medicare Advantage and ACA Risk Adjustment and RADV analysis
- Large Group pricing model development and maintenance
- IBNR and PDR actuarial accrual development
- Provider contract, network design and area factor analysis
KEY REQUIREMENTS
- ASA required; FSA preferred
- 8+ years actuarial experience in health insurance
- Hands-on Medicare Advantage pricing and bid process experience
- Experience with Medicare Advantage and ACA Risk Adjustment and RADV
- Proficient in Excel, Access and SAS and/or SQL-based tools
TECH STACK
- Excel
- Access
- PowerPoint
