Director, Actuarial Services

Overview

This role leads the development, implementation, and oversight of actuarial models and financial frameworks supporting value-based care partnerships. Responsibilities include reserving, forecasting, contract reconciliations, and performance-related actuarial support across a portfolio of partners, including risk-based entities, regional plans, and national plans. The Director will regularly collaborate with C-suite leaders and help advance financial structures through actuarial studies and industry expertise.

Responsibilities

• Lead development and reporting for total cost of care savings performance estimates across a portfolio of partners, ensuring data accuracy and methodological consistency with risk-based contracts and actuarial standards.
• Lead annual financial reconciliations for a portfolio of value-based contracts, coordinating internal data resources and working directly with actuarial counterparts at existing partners to validate results.
• Assess the reliability of performance estimates, identify and quantify financial risks and opportunities, and advise the Finance team on revenue recognition decisions tied to projected shared savings.
• Identify and evaluate areas of potential underperformance, interpret results, and partner with health economics and clinical teams to determine root causes of emerging issues.
• Conduct actuarial analyses and develop models that quantify financial and risk trade-offs among different contract features in value-based arrangements.
• Support the development and maintenance of financial models that connect clinical and operational activities to outcomes driving financial performance.

Required Qualifications

• Bachelor’s degree in Statistics, Actuarial Sciences, Economics, Math, or another quantitative discipline.
• Associateship or Fellowship from the Society of Actuaries (ASA or FSA).
• 8+ years of actuarial experience in health care and/or medical economics.
• 2+ years of experience mentoring junior staff members.
• Understanding of Medicare Advantage health plan data, including Claims, MMR, and MAO-04.
• Experience using SQL or another coding language to pull and transform data in a structured manner from large healthcare claims databases.
• Proficiency in writing clean, efficient code and maintaining strong data management practices.
• Experience working across organizations and building rapport with data teams and downstream consumers.

Preferred Qualifications

• 3+ years of experience in value-based care arrangements and contracting, with a focus on reserving and forecasting for shared savings programs, shared risk programs, and/or global capitation.
• Strong communication skills and the ability to articulate the “Here’s What,” the “So What,” and the “Now What” to executive audiences or external parties.
• Strong understanding of financial and clinical metrics used in healthcare and working knowledge of industry standards for presenting data.
• Experience developing financial models and/or forecasts in Excel to evaluate the cost-of-care impact of different clinical interventions.
• Familiarity with BI tools such as Looker, Tableau, or Power BI.
• Understanding of pharmacy benefits and/or Medicare Part D.

Success Factors

• Acts with members in mind and is deeply committed to the member experience.
• Maintains high standards for data accuracy, presentation, and documentation; detects data anomalies and identifies outputs requiring further investigation.
• Takes action, prioritizes initiatives effectively, and ensures urgent and important needs are addressed promptly.
• Has a proven track record of success in scaling businesses, fast-paced environments, and startups, with comfort navigating changes to business strategy, organization, and priorities.
• Applies healthcare data and financial expertise to tactical decisions and strategic plans, right-sizes solutions, and tailors communication to the audience.

Compensation & Benefits

• Base salary: $190,000 to $210,000.
• Total compensation also includes equity, benefits, and other opportunities.
• Individual pay decisions are based on qualifications, experience level, skillset, and internal equity.
• The salary range could be lower or higher if the role is hired at another level.
• The employer is an equal-opportunity employer and is committed to inclusion and diversity of perspectives.