Overview
The Director, Actuarial – Government Programs will lead actuarial pricing, financial performance insights, and strategic analytics for Medicare and Medicaid lines of business. This role ensures market-competitive, compliant, and financially sustainable products by translating actuarial insights into actionable business decisions. The position requires collaboration across Finance, Product, Network, Risk Adjustment, and Clinical teams to support growth strategy in a matrixed environment.
Responsibilities
- Lead end-to-end pricing for Medicare Advantage, Medicaid, and related government programs.
- Develop and maintain actuarial assumptions, methodologies, and pricing models.
- Ensure rate adequacy, competitiveness, and alignment with enterprise financial targets.
- Oversee bid development, rate filings, and regulatory submissions.
- Translate pricing assumptions into forward-looking financial projections and scenarios.
- Monitor emerging experience versus pricing assumptions and identify key drivers of variance.
- Provide actionable insights to improve margin, membership growth, and cost management.
- Ensure compliance with CMS, state Medicaid agencies, and insurance department requirements.
- Support actuarial certifications, rate filings, and audit readiness.
- Interface with regulators and external actuarial partners as needed.
- Partner with Product, Network/Provider Contracting, and Clinical teams on benefit design, product strategy, value-based care, provider reimbursement models, and cost/utilization management strategies.
- Align actuarial assumptions with operational and market realities across the enterprise.
- Lead and develop a high-performing team of actuaries and analysts.
- Establish clear priorities, governance, and quality standards for actuarial work products.
- Foster a culture of innovation, continuous improvement, and accountability.
- Contribute to enterprise planning, budgeting, and long-term strategy.
- Present insights and recommendations to senior leadership clearly and actionably.
- Identify opportunities for automation, analytics advancement, and process optimization.
Requirements
- Bachelor's Degree required.
- Minimum 5 years of management experience.
- Minimum 7 years of actuarial experience.
- Associate of the Society of Actuaries (ASA) designation required.
- Fellow of the Society of Actuaries (FSA) designation preferred.
Compensation & Benefits
- Medical, Dental, and Vision insurance plans.
- Adoption, Fertility, and Surrogacy Reimbursement up to $10,000.
- Paid Time Off and Sick Leave.
- Paid Parental and Family Caregiver Leave.
- Emergency Backup Care.
- Long-Term, Short-Term Disability, and Critical Illness insurance plans.
- Life Insurance.
- 401k/403B retirement plan with employer match.
- Tuition Assistance up to $5,250 per year and discounted educational opportunities.
- Student Debt Pay Down up to $10,000.
- Reimbursement for certifications and free access to continuing education units and professional development.
- Pet Insurance.
- Legal Resources Plan.
- Eligibility for an annual discretionary bonus based on system and employee criteria.
Location
Position based in Norfolk, VA with a first (day) shift schedule.
Remote work opportunities are available for associates residing in the following states: Alabama, Delaware, Florida, Georgia, Idaho, Indiana, Kansas, Louisiana, Maine, Maryland, Minnesota, Nebraska, Nevada, New Hampshire, North Carolina, North Dakota, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Washington, West Virginia, Wisconsin, and Wyoming.