Job Description
A bit about this role:
The Pricing Actuary is a critical actuarial leader responsible for directing the strategy, modeling, and financial execution of our Commercial lines of business (e.g., Group and Self-Funded/ASO). This role requires deep expertise in Commercial rating mechanics, rating model architecture, underwriting strategy, and state regulatory rate filings.
Beyond pure technical depth, success in this role hinges on flawless operational execution: building robust pricing infrastructure, hitting non-negotiable regulatory submission deadlines, bringing process consistency to rating cycles, and working collaboratively with underwriting, sales, finance, network contracting, and state regulators.
We place the highest value on proven real-world execution, technical ability, and collaborative leadership. While professional actuarial credentials are recognized, a track record of driving timely, accurate, and profitable Commercial rating and rate review outcomes is what truly defines success in this role.
Your Responsibilities and Impact will include:
Rating Model Development & Architecture
Rating Engine & Model Building: Build, refine, and maintain scalable actuarial rating models and pricing engines across Commercial Large Group lines of business, ensuring high technical standards and repeatable execution.
Product & Benefit Pricing Strategy: Partner with product, clinical, and market leadership to rate competitive benefit packages, evaluating product trade-offs, cost-sharing mechanics, and benefit design changes against profitability targets.
Assumption & Trend Development: Establish, defend, and document core actuarial pricing assumptions, including manual rates, age/gender factors, area factors, trend projections, administrative expense allocations, and margin targets.
Underwriting Partnership & Group Pricing
Underwriting Collaboration: Contribute directly to underwriting policy and risk selection strategies for group business, providing actuarial oversight on complex quote requests, experience rating formulas, and credibility logic.
ASO & Stop-Loss Pricing: Design and maintain pricing methodologies for Administrative Services Only (ASO) products, employer-specific fee structures, and stop-loss/reinsurance coverage options.
Portfolio & Risk Analysis: Monitor group risk profiles, employer group renewal performance, and adverse selection dynamics, feeding insights back into rate development and underwriting guidelines.
Regulatory Submissions, Rate Reviews & State Engagement
State Rate Filings & Defensibility: Direct the preparation, documentation, and filing of annual and quarterly Commercial rate filings across multiple state departments of insurance (DOIs) and regulatory bodies.
State Regulatory Relations: Serve as the primary actuarial interface with state regulators throughout the rate review process, responding promptly and effectively to regulatory objections, actuarial inquiries, and public comments to secure necessary rate approvals.
ACA Financial Mechanics: Oversee pricing mechanics related to Commercial regulatory frameworks, including ACA risk adjustment (HHS-HCCs), Medical Loss Ratio (MLR) rebate calculations, state rate cap mandates, and the No Surprises Act.
Cross-Functional Collaboration & Strategic Alignment
Cross-Functional Partnership: Work seamlessly across Finance, Healthcare Economics, Sales/Distribution, Network Management, and Clinical Operations to ensure rating assumptions reflect actual operational capabilities, market distribution goals, and provider contracting terms.
Executive Presentation: Prepare clear, compelling executive-level presentations summarizing rate filing strategies, portfolio rate impacts, and margin projections for executive leadership, board members, and key business partners.
Required skills and experience:
(Hands-on execution ability, proven track record, and collaborative performance take precedence over formal degrees or certifications).
Core Actuarial &…