Job Description
A bit about this role:
The Pricing Actuary is a critical actuarial leader responsible for directing the strategy, modeling, and execution of our annual Medicare Advantage (MA) bidding process. This role demands deep, battle-tested expertise in Medicare Advantage bid preparation, rate cell modeling, CMS regulations, and risk adjustment mechanics.
Beyond pure technical depth, success in this role hinges on flawless operational execution: hit non-negotiable regulatory deadlines, bring process consistency to complex financial cycles, and work collaboratively across market leadership, clinical teams, finance, and executive stakeholders.
We place the highest value on proven real-world execution, technical precision, and collaborative leadership. While professional actuarial credentials are recognized, a track record of driving timely, accurate, and strategic MA bids is what truly defines success in this role.
Your Responsibilities and Impact will include:
Medicare Advantage Bid Strategy & Execution Annual Bid Leadership: Direct and oversee the end-to-end development, modeling, and submission of annual Medicare Advantage (Part C and Part D) bids, ensuring total compliance with CMS guidelines and strict adherence to statutory deadlines.
Product & Benefit Pricing Strategy: Partner with product, clinical, and local market leaders to design competitive benefit packages, evaluating product trade-offs, supplemental benefits, and cost-sharing mechanics against financial and growth targets.
Assumption Development: Establish, defend, and document core actuarial bid assumptions, including baseline utilization, unit cost trends, risk adjustment factors, administrative expense allocations, and margin targets.
Modeling, Technical Rigor & Process Consistency Actuarial Modeling & Automation: Build, refine, and maintain scalable bid pricing models, ensuring high standards of technical accuracy, model governance, and repeatable execution across expanding market footprints.
Sensitivity & Scenario Analysis: Perform complex scenario testing and sensitivity analyses to quantify the financial impacts of proposed CMS payment policy changes, risk model updates, benchmark shifts, and competitive market dynamics.
CMS Regulatory Translation: Interpret annual CMS Call Letters, Bid Instructions, and Rate Announcements, translating regulatory changes into actionable modeling adjustments and executive strategic guidance.
Cross-Functional Collaboration & Strategic Alignment Cross-Functional Partnership: Work seamlessly across Finance, Healthcare Economics, Clinical Operations, and Network Management to ensure bid assumptions reflect actual operational capabilities, clinical programs, and provider contracting terms.
Data Integration & Quality Assurance: Partner closely with data engineering and analytics teams to ensure the integrity, completeness, and accuracy of historical claims, enrollment, and risk adjustment data fed into bid models.
Executive & Regulatory Presentation: Prepare clear, compelling executive-level presentations summarizing bid strategy, financial returns, and risk profiles for executive leadership, board members, and regulatory reviewers.
Required skills and experience:
(Hands-on execution ability, proven track record, and collaborative performance take precedence over formal degrees or certifications).
Core Actuarial & MA Experience: 8+ years of progressive healthcare actuarial experience, with at least 5+ years of deep, direct focus on Medicare Advantage bid pricing, plan design, and CMS bid submission.
Proven Track Record of Deadline Execution: Demonstrated ability to consistently drive complex, time-sensitive projects to completion on schedule, managing high-stakes regulatory deadlines with poise and precision.
Technical & Modeling Expertise: Advanced proficiency in actuarial modeling, claims data extraction, and financial modeling tools (e.g., SQL, Python, R, SAS, or advanced Excel modeling).
Deep Regulatory Mastery: Thorough…