Executive Director - Chief Actuary

Presbyterian Healthcare Services

11d

About The Position

The Chief Actuary is the senior leader responsible for actuarial services, underwriting, pricing, reserving, forecasting, and insurance risk management. This role contributes to the financial soundness of the health plan, provides strategic insight to executive leadership, and oversees all actuarial and underwriting functions supporting government and commercial lines of business. The Chief Actuary serves as the Appointed Actuary and is accountable for regulatory compliance, actuarial governance, and the development of actuarial talent.

Requirements

BA or BS in actuarial science, math, or og
Fellow of the Society of Actuaries (FSA) or Associate of the Society of Actuaries (ASA) required; Member of the American Academy of Actuaries (MAAA) required.
10+ years of actuarial experience in health insurance, with significant leadership responsibility.
Extensive knowledge of and experience in Medicaid
General knowledge and experience in Medicare Advantage, ACA, and/or commercial health markets
Expertise in pricing, reserving, forecasting, and regulatory filings.
Strong executive communication skills and ability to influence senior leadership.
Proven ability to lead teams and manage complex, multi stakeholder initiatives.

Nice To Haves

Experience in value based care, risk adjustment, and population health analytics.
Background in enterprise risk management or capital strategy.
Ability to translate complex actuarial concepts into actionable business insights.
Strategic thinker with a bias for collaboration and innovation.
Demonstrated ability to develop practical solutions and drive outcomes

Responsibilities

Product and Pricing Strategy
Evaluate and Promote Medicaid Rate Adequacy & State Partnership
Oversee evaluation of capitation rate assumptions.
Partner directly with the state Medicaid agency to ensure assumptions are reasonable, risk is managed, and rates are actuarially sound.
Support rate negotiations and data submissions to the state and CMS.
Analyze the impact of risk adjustment models, acuity shifts, redeterminations and eligibility churn, directed payments and supplemental payment programs, changes in covered benefits, eligible population, and provider payment schedule changes.
Ensure Commercial and Medicare rates balance competitiveness and adequacy, and comply with applicable regulatory standards
Set premium rates for individual, small group, large group, and government programs (e.g., Medicare Advantage, Affordable Care Act marketplace plans).
Oversee trend analysis (medical cost inflation, utilization changes, provider contracting impacts).
Approve final rate filings submitted to state and federal regulators.
Product Development, Underwriting and pricing
Partner with product, underwriting, and finance teams to support new product design and market expansion.
Supervise the underwriting team
Maintains and updates pricing models to evaluate rating impact of regulatory changes and benefit plan changes
Financial Oversight & Forecasting
Oversee actuarial balance sheet items:
Claims liability reserves (IBNR) estimation
Provider incentive payments or receivables
Premium deficiency reserves
Risk corridor payables/receivables
Risk adjustment revenue projections
Partner with finance team on forecasting
Lead actuarial analytics teams.
Analyze and explain drivers of rolling trends in claims experience, provider contract performance, pharmacy costs, and population health metrics
Regulatory & Statutory Accountability
Sign statutory actuarial opinions.
Interface with:
State Department of Insurance
State Medicaid agency
Centers for Medicare & Medicaid Services
Oversee compliance with Medicaid managed care rate certification standards.
Ensure adherence to minimum MLR requirements.
Certify compliance with mental health parity quantitative treatment limits
(Oversee commercial product risk adjustment submissions and validation)
Governance & Talent Leadership
Maintain actuarial standards (e.g., compliance with the Actuarial Standards of Practice).
Recruit and develop actuarial leadership.
Maintain relationships with external auditors and consulting actuaries.