Director, EGWP Actuary
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 role has substantial independence to formulate and administer actuarial policies and programs, set strategic direction, manage operations and budget, and oversee Medicare Part D pricing, bids, reserving, and monthly close. The Director builds and leads the actuarial function through subordinate managers and senior actuarial professionals, with authority over hiring, performance management, promotions, and exits. The role manages 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 implementation decisions, and is accountable for results affecting the financial performance of the EGWP line of business and the broader organization. This position requires deep actuarial expertise, business and financial acumen, and the ability to influence executive decision-making. It is hybrid and requires the employee to be local to the Denver, New York City, or Charlotte area.
Requirements
- Bachelor’s degree in mathematics or a related field and at least 12 years of actuarial experience, including deep Medicare Part D experience; additional equivalent work experience in a directly related field may substitute for the degree requirement.
- At least 6 years of people leadership experience with direct reports, including leading managers or senior professionals and managing a departmental budget.
- Expert-level experience developing pricing for Part D EGWP and understanding of how individual decisions affect the overall bid.
- In-depth knowledge of CMS bid processes, risk-adjustment methodologies, and regulatory requirements.
- Excellent communication and influencing skills, with a track record of presenting to and advising executive leadership.
- Proactive and adaptable mindset, with the ability to thrive 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, with final decision-making authority 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 the monthly close, including IBNR reserves, claims adjustments, and revenue estimates; establish team controls and review standards.
- Oversee experience analysis, trend forecasting, and risk assessments, using results to guide decisions that optimize financial performance.
- Lead the underwriting strategy and process for a growing client book, ensuring CMS compliance 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; formulate actuarial policies and programs in response.
- 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 supporting forecasting, reserving, and strategic decisions.
- Improve existing processes, automate workflows, and enhance the function’s analytical capabilities.
- Serve as the subject matter authority for EGWP and Part D financial matters and present findings, recommendations, and actuarial concepts to executive leaders and external stakeholders.
- Coach and develop managers and actuarial staff; set performance goals, conduct performance reviews, and make final decisions on hiring, promotions, and exits.
- Influence senior business partners by translating complex actuarial concepts into actionable recommendations and initiating actuarial and financial advice in compliance with Actuarial Standards of Practice.
- Establish standards, frameworks, and assumption-setting approaches for new, existing, and non-traditional actuarial models.
- Adhere to the Capital Rx Code of Conduct and report noncompliance.
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What This Job Offers
Job Type
Full-time
Career Level
Director
