Director Actuarial Services

Tuesday Health

2d•Hybrid

About The Position

The Director, Actuarial Services leads the actuarial function supporting Tuesday Health's value-based contracts with health plan and payer partners. This role owns the quantitative foundation of Tuesday Health's risk-bearing arrangements: calculating customer settlements, supporting contract negotiations with sound actuarial analysis, pricing and underwriting new and renewing contracts, and producing the claims-based reporting and trend analysis that inform both external partner discussions and internal clinical and operational strategy. This role requires actuarial expertise specifically grounded in value-based care and alternative payment models, applied to a serious-illness and palliative care population with distinctive utilization and cost patterns. The Director will work closely with Tuesday Health's Data & Analytics, Finance, and Growth teams, and will represent Tuesday Health directly to payer-side actuarial and analytics counterparts.

Requirements

Substantial actuarial experience in value-based care, alternative payment models, or other risk-bearing healthcare arrangements (e.g., ACOs, Medicare Advantage risk arrangements, shared savings/shared risk programs, capitation).
Hands-on experience with claims-based underwriting, pricing, and risk assessment for provider organizations, payers, or risk-bearing entities.
Experience leading or directly performing settlement calculations and financial reconciliations under value-based contracts.
Experience supporting payer contract negotiations with actuarial and financial analysis.
Strong claims data analysis skills, including experience identifying and explaining cost and utilization trends.
Bachelor's degree in actuarial science, mathematics, statistics, economics, or a related quantitative field.
Strong written and verbal communication skills, including the ability to explain actuarial findings to non-actuarial audiences, both internal and customer-facing.

Nice To Haves

Fellow (FSA) or Associate (ASA) of the Society of Actuaries; Member of the American Academy of Actuaries (MAAA).
Experience in complex/high-acuity value-based populations.
Experience with CMS alternative payment models (e.g., ACO REACH, Medicare Shared Savings Program) or Medicare Advantage risk-adjustment methodologies (e.g., HCC models).
Experience working directly with SQL or similar tools to query and analyze large claims datasets.
Experience managing or mentoring actuarial or analytical staff.

Responsibilities

Lead customer settlement calculations for value-based contracts, including reconciliation of actual performance against contractual targets (e.g., shared savings, shared risk, or total cost of care benchmarks), ensuring calculations are accurate, defensible, and clearly documented for both internal and external stakeholders.
Support contract negotiations with health plan and payer partners by developing and presenting actuarial analyses of proposed terms, risk arrangements, benchmarks, and financial projections, and by advising.
Own underwriting for new and renewing contracts, including pricing analysis, risk assessment of new populations and markets, and development of actuarially sound assumptions for program growth and expansion.
Produce claims-based reporting covering cost, utilization, and quality metrics for internal leadership and external customers, ensuring reporting methodology is consistent, transparent, and aligned with contractual definitions.
Lead deep-dive analyses of claims trends, identifying drivers of cost and utilization (e.g., hospitalization, emergency department use, post-acute care) and translating findings into actionable input for clinical, operational, and growth strategy.
Maintain actuarial soundness of financial projections, reserves, and risk assessments related to Tuesday Health's value-based and risk-bearing arrangements, consistent with applicable Actuarial Standards of Practice (ASOPs).
Partner with Data & Analytics and Medical Economics to ensure claims and utilization data used in actuarial work is complete, accurate, and appropriately sourced from Tuesday Health's data infrastructure.
Represent Tuesday Health in technical discussions with payer-side actuaries and analytics teams, building credibility and trust in Tuesday Health's methodology and results.
Build and mentor actuarial and analytical capability as the function grows, establishing repeatable methodology and documentation for recurring actuarial processes (settlements, underwriting, trend reporting).
Other duties may be assigned.