Director, EGWP Actuary

Judi Health•Charlotte, NC

2d•Hybrid

About The Position

The Director, EGWP Actuary directs the strategy, governance, and operations of Judi Health’s EGWP actuarial function and serves as the accountable actuarial leader for the EGWP line of business. Reporting to the VP, Actuarial & Underwriting, the Director has substantial independence to formulate and administer actuarial policies and programs; make decisions about strategic direction, operations, and budget; and oversee Medicare Part D pricing, bids, reserving, and monthly close. The Director builds and leads the EGWP actuarial team through subordinate managers and senior actuarial professionals, with authority for hiring, performance management, promotions, and exits. The role is accountable for significant human and financial resources and partners with senior and executive leaders across sales, underwriting, EGWP, PBM, and finance. It translates business segment strategy into functional plans, makes final decisions on implementation, and is accountable for results affecting the financial performance of the line of business and broader organization. The role requires deep actuarial expertise, strong business and financial acumen, and the ability to influence executive decision-making. The Director establishes standards and assumption-setting approaches for actuarial models, provides actuarial and financial advice in compliance with the Actuarial Standards of Practice, and serves as a subject matter authority for EGWP and Part D financial matters. The position is hybrid and local to the Denver, NYC, or Charlotte area.

Requirements

Bachelor’s degree in mathematics or a related field, or equivalent work experience in a directly related field in place of the degree requirement.
At least 12 years of actuarial experience, with deep experience in Medicare Part D.
At least six years of people leadership experience with direct reports, including leading managers or senior professionals and managing a departmental budget.
Expert-level experience developing pricing related to Part D EGWP.
Understanding of the nuances of EGWP pricing and how each decision affects the overall bid.
In-depth knowledge of CMS bid processes, risk adjustment methodologies, and regulatory requirements.
Excellent communication and influencing skills, with experience presenting to and advising executive leadership.
Proactive and adaptable approach, with the ability to work in an evolving, entrepreneurial environment.
Associate of the Society of Actuaries or Fellow of the Society of Actuaries.

Nice To Haves

Prior EGWP experience.
Experience building or scaling an actuarial function in a growing or entrepreneurial organization.
Programming experience with SQL, SAS, Python, or R.

Responsibilities

Direct the development, maintenance, and enhancement of Medicare Part D financial models, including settlements, forecasting, and experience monitoring.
Set and approve EGWP bid actuarial strategy and governance, including assumptions, pricing recommendations, risk thresholds, and profitability targets, and make final decisions on implementation.
Partner with the VP, Actuarial & Underwriting and senior leadership to establish EGWP strategic plans and objectives, translate business strategy into functional plans, and contribute to organizational policies.
Own and approve actuarial components of monthly close, including IBNR reserves, claims adjustments, and revenue estimates; establish team controls and review standards.
Oversee experience analysis, trend forecasting, and risk assessments and use findings to support decisions that optimize line-of-business financial performance.
Lead underwriting strategy and processes for a growing client book while ensuring compliance with CMS regulations and competitive market positioning.
Reconcile emerging monthly experience with models and approve assumption updates as needed.
Build and lead the EGWP actuarial function, including organizational design, workforce planning, hiring, performance management, promotions, exits, and talent development.
Develop and manage the EGWP actuarial department budget and resource allocation.
Monitor and evaluate CMS regulations, payment methodologies, and Part D risk adjustment impacts, and formulate responsive actuarial policies and programs.
Oversee actuarial models, analytical capabilities, controls, and processes to ensure accuracy, scalability, and effective risk management.
Provide technical direction on complex modeling and analysis of large healthcare datasets for forecasting, reserving, and strategic decision-making.
Improve processes, automate workflows, and enhance analytical capabilities across the actuarial function.
Serve as the recognized subject matter authority for EGWP and Part D financial matters.
Present findings, recommendations, and actuarial concepts clearly to executive leadership and key external stakeholders.
Coach and develop managers and actuarial staff; set performance goals, conduct performance reviews, and make final decisions on hiring, promotions, and exits.
Translate complex actuarial concepts into actionable recommendations for senior business partners and initiate actuarial and financial advice in compliance with the Actuarial Standards of Practice.
Establish standards, frameworks, and assumption-setting approaches for new, existing, and non-traditional actuarial models to meet business needs.
Adhere to the Capital Rx Code of Conduct, including reporting noncompliance.