VP, Medicare Advantage Chief Actuary

Overview

This role provides oversight, strategic direction, process improvements, and best practices for the Medicare Advantage actuarial function. Responsibilities include all actuarial and underwriting/pricing functions supporting Medicare Advantage plan operations.

The position partners closely with leaders across Risk Adjustment, Pharmacy, Health Plan Product, and Stars Strategy to deliver forward-thinking strategies and business direction for actuarial rate setting, pricing, annual CMS Part C and Part D bid submissions, risk adjustment factor forecasting, premium development, valuation and statutory reserve setting (including IBNR), financial risk management, product development, and performance analytics to support long-term financial sustainability, market competitiveness, and high Star Ratings performance.

Candidates must be authorized to work in the United States; the employer is unable to sponsor visas for this role at this time.

Responsibilities

Strategic Leadership & Talent Development

• Develop, implement, and guide strategic direction for the Medicare Advantage actuarial function.
• Oversee, coach, mentor, motivate, support, and develop a cross-functional team.
• Build specialized internal capabilities in Medicare Advantage pricing, Part D benefit economics, reserving, risk adjustment, healthcare economics, and advanced healthcare analytics.
• Oversee goal setting and review, regular guidance and 1-1 check-ins, career development/planning, upskilling, resource allocation, staffing, budget creation/management, and succession planning.
• Foster accountability, collaboration, and innovation to ensure organizational goals are met.

Executive Business Intelligence & Plan Performance

• Support cross-functional alignment to ensure strong business intelligence and understanding of financials shared with the executive team and the Board.
• Provide visibility into emerging Medical Loss Ratios (MLR), emerging claims trends, membership and revenue dynamics, member cohort profitability, risk score performance, and regulatory revenue shifts.

MA Product Design & Pricing Architecture

• Serve as primary actuarial authority for Medicare Advantage product strategy and pricing.
• Partner with Health Plan Product, Clinical, Pharmacy, Network, Finance, and Market Growth leaders to evaluate:
  • Plan Benefit Packages (PBPs)
  • Supplemental benefits (e.g., dental, vision, hearing, OTC allowances)
  • Formulary and cost-sharing structures
  • Service-area expansion
  • Specialized plan offerings
• Balance member value, growth objectives, competitive positioning, regulatory requirements, and margin targets.

Valuation, Reserving & Risk Management

• Own actuarial valuation for financial reporting functions.
• Oversee pricing and valuation for all plan offerings.
• Direct estimation and review of unpaid claim liabilities (IBNR), premium deficiency reserves, and risk-sharing settlements in accordance with statutory accounting principles (SAP), NAIC guidelines, and CMS Minimum Medical Loss Ratio (85% MLR) standards.
• Enhance risk management, internal controls, and pricing policies/procedures.

CMS Bid Strategy & Submission Execution

• Lead end-to-end development, actuarial modeling, review, documentation, certification, and HPMS submission of annual Medicare Advantage Part C and Part D bids.
• Ensure 100% on-time adherence to statutory CMS June deadlines and full compliance with CMS Bid Instructions, Call Letters, and Actuarial Standards of Practice (ASOPs).
• Establish assumption governance, scenario testing, quality controls, executive review, and bid-to-actual monitoring.
• Ensure compliance across all bid activities.

Regulatory Policy & Executive Strategy

• Inform and participate in pricing strategy discussions with the executive team.
• Interpret and model financial impacts of CMS Advance Notices, Final Rate Announcements, county benchmark adjustments, and risk adjustment model changes (including the transition from CMS-HCC V24 to V28).
• Partner with the VP of Risk Adjustment to align risk score progression forecasts with bid pricing assumptions.
• Develop and implement pricing strategies and methods to adapt to market dynamics.

Regulatory Financial Settlement & Guidance

• Ensure actuarial financial statement items are established in accordance with relevant actuarial, regulatory, and accounting guidance, including:
  • CMS Part D risk corridor reconciliations
  • Low-income cost-sharing (LICS) subsidies
  • Federal reinsurance settlements
  • Risk Adjustment Data Validation (RADV) accruals

Governance, Quality Assurance & Audit Readiness

• Oversee creation of, and adherence to, key processes, procedures, analyses, and techniques.
• Guide adoption of best practices to minimize inaccuracies and ensure compliance with legal, regulatory, and business requirements.
• Maintain audit readiness for CMS financial exams, RADV audits (in coordination with the Risk Adjustment team), and RAPS/EDPS encounter data reviews.

Innovative Methodologies & Star Ratings Economics

• Drive continuous improvement by monitoring industry trends and developing tools and techniques that support innovative actuarial methodology and adoption of actuarial best practices.
• Collaborate with the VP of Quality and Stars Strategy to quantify and incorporate financial implications of CMS Star Ratings (Quality Bonus Payments and rebate percentages) into long-term strategic plans and multi-year bid curves.

Cross-Functional Partnerships & Value-Based Care Alignment

• Build strong cross-department relationships and serve as a liaison.
• Consult, influence, and share data review/results to support adoption of strategically-sound, statistically-appropriate business opportunities.

Actuarial Program Leadership

• Provide strategic direction for the actuarial program.
• Establish consistent study time and exam-related guidelines to foster credentialing (ASA/FSA/MAAA) across junior and mid-level staff.

Performance Analytics & Executive Dashboards

• Provide pricing analysis, reports, and dashboards to track performance.
• Maintain detailed bid-to-actual variance analyses, inpatient/outpatient unit cost trends, and risk score trajectory tracking.

Requirements

• Bachelor’s degree in Actuarial Science, Mathematics, Statistics, Economics, or related quantitative field.
• Fellow of the Society of Actuaries (FSA) and a Member of the American Academy of Actuaries (MAAA) in good standing, meeting qualification standards to issue Statements of Actuarial Opinion and CMS Medicare Advantage Part C and Part D Actuarial Certifications.
• 15+ years of health actuarial experience, including 7–10 years of direct senior leadership experience in:
  • Medicare Advantage bid preparation
  • Part C/Part D pricing development
  • Reserving
  • Risk adjustment
  • CMS health plan financial management
• Significant executive leadership experience within a Medicare Advantage organization, health maintenance organization (HMO), or national managed care carrier (e.g., Humana, Devoted, UnitedHealth, or prominent regional MA plans), with direct exposure to executive leadership and governing boards.
• Expert understanding of CMS bid mechanics, HPMS filings, CMS-HCC and RxHCC risk adjustment models, Part D direct subsidy/formulary economics, Star Ratings financial mechanics, and statutory IBNR reserving.
• Strong financial knowledge and deep understanding of healthcare economics and actuarial/accounting aspects, specifically value-based care delivery, capitation, two-sided risk sharing, and Medicare Advantage statutory balance sheet management.
• Proven ability to develop, support, coach, mentor, and empower cross-functional teams of credentialed actuaries, students, and healthcare economics data analysts.
• Proven ability to develop pricing strategies and plans for new products and innovative services, including specialized MA plans (e.g., Chronic or Dual-Eligible SNPs) and consumer-centric supplemental benefit packages.
• Proven ability to collaborate across functional teams and organizational levels to deliver results under strict statutory timelines (including the annual June CMS bid deadline).
• Demonstrated ability to partner with sales and growth teams to evaluate Annual Enrollment Period (AEP) targets, geographic service area expansions, and competitive market positioning.
• Strong communication and negotiation skills; experience presenting complex actuarial models and financial trade-offs to Executive Leadership, Plan Leaders, and Board Committees.
• Ability to organize and prioritize dynamic workflow during high-pressure bid cycles and regulatory filing windows.
• Ability to work with integrity and continuously uphold organizational values.
• Excellent written and verbal communication skills with ability to influence at all levels.

Preferred Qualifications

• Not specified.

Compensation & Benefits

Hiring range (base salary)

• $175,300.00–$249,100.00

Benefits

• Medical, Vision and Dental Plans
• Tax-Advantage Savings Accounts (FSA & HSA)
• Life Insurance and Disability Insurance
• Paid Time Off (PTO, Sick Time, Paid Leave, Volunteer & Wellness Days)
• Employee Assistance Program
• 401k with company match
• Employee Resource Groups
• Employee Discount Program
• Learning and Development Opportunities
• Additional benefits as applicable

Location & Work Details

• Virtual – Microsoft Teams
• Full time
• Not member or patient facing

Working Conditions

• Normal office working conditions.

COVID-19 Vaccination Requirement

Personnel who interact with at-risk members or prospects are required to have completed, at a minimum, the initial series of an approved COVID-19 vaccine. If this role is identified as member-facing, proof of vaccination will be required as a condition of employment.

Additional Information

• Drug screen requirement: No
• MVR required: No
• Credit check required: No

Equal Employment Opportunity

The employer is an EEO/AA employer M/F/V/D.

Disclaimer

This job description describes the general nature and level of work performed by people assigned to this job and is not intended to be an exhaustive list of responsibilities, duties, and skills required. Physical activities, demands, and working conditions represent those encountered while performing essential functions. Reasonable accommodations may be made for individuals with disabilities to perform essential job duties and responsibilities.