VP, Medicare Advantage Chief Actuary

Lumeris

4d•$175,300 - $249,100•Remote

About The Position

The VP, Medicare Advantage Chief Actuary provides strategic direction, oversight, process improvements, and best practices for the actuarial function supporting Essence Healthcare’s Medicare Advantage plan operations. The role leads actuarial and underwriting/pricing activities and partners with leaders in Risk Adjustment, Pharmacy, Health Plan Product, and Stars Strategy to guide actuarial rate setting, pricing, annual CMS Part C and Part D bid submissions, risk adjustment forecasting, premium development, valuation and statutory reserves, financial risk management, product development, and performance analytics. The objective is to support long-term financial sustainability, market competitiveness, and strong Star Ratings performance. The position leads and develops a cross-functional actuarial team, oversees financial and plan-performance reporting for executive leadership and the Board, and serves as the primary actuarial authority for Medicare Advantage product strategy and pricing. It directs valuation and reserve work, including unpaid claim liabilities and risk-sharing settlements, and leads the end-to-end preparation, certification, and submission of annual CMS bids. The role also interprets regulatory changes, ensures appropriate financial settlements and accounting, maintains governance and audit readiness, develops actuarial methods, and aligns pricing and analytics with value-based care objectives. The position is based in a virtual work setting using Microsoft Teams. The employee works in normal office conditions. This is a non-member-facing role.

Requirements

Bachelor’s degree in Actuarial Science, Mathematics, Statistics, Economics, or a related quantitative field.
Fellow of the Society of Actuaries (FSA) and Member of the American Academy of Actuaries (MAAA) in good standing, meeting qualification standards to issue Statements of Actuarial Opinion and CMS Medicare Advantage Part C and Part D actuarial certifications.
15 or more years of health actuarial experience, including 7–10 years of direct senior leadership experience in Medicare Advantage bid preparation, Part C/Part D pricing, reserving, risk adjustment, and CMS health plan financial management.
Significant executive leadership experience within a Medicare Advantage organization, HMO, or managed-care carrier, including direct exposure to executive leadership and governing boards.
Expert understanding of CMS bid mechanics, HPMS filings, CMS-HCC and RxHCC risk adjustment models, Part D subsidy and formulary economics, Star Ratings financial mechanics, and statutory IBNR reserving.
Deep financial knowledge of healthcare economics, actuarial and accounting matters, value-based care delivery, capitation, two-sided risk sharing, and Medicare Advantage statutory balance-sheet management.
Ability to develop, support, coach, mentor, and empower a cross-functional team of credentialed actuaries, actuarial students, and healthcare economics data analysts.
Ability to develop pricing strategies and plans for new products and services, including specialized Medicare Advantage plans and supplemental benefit packages.
Ability to collaborate across functions and organizational levels and deliver results under strict statutory timelines, including the annual June CMS bid deadline.
Ability to partner with sales and growth teams on Annual Enrollment Period targets, service-area expansions, and competitive market positioning.
Strong communication and negotiation skills, including presenting complex actuarial models and financial trade-offs to executives, plan leaders, and Board committees.
Ability to organize and prioritize changing workloads during high-pressure bid cycles and regulatory filing windows.
Ability to work with integrity, act ethically, and uphold organizational values.
Excellent written and verbal communication skills and the ability to influence at all levels.

Responsibilities

Develop, implement, and guide the strategic direction of the Medicare Advantage actuarial function.
Lead, coach, mentor, and develop a cross-functional team; oversee goal setting, career development, staffing, resource allocation, budgeting, succession planning, and related people programs.
Provide executive business intelligence and communicate company financial and plan-performance information to the executive team and Board of Directors.
Oversee analysis of emerging medical loss ratios, claims trends, membership and revenue dynamics, cohort profitability, risk-score performance, and regulatory revenue changes.
Serve as the primary actuarial authority for Medicare Advantage product strategy and pricing, partnering with product, clinical, pharmacy, network, finance, and market-growth leaders.
Evaluate plan benefit packages, supplemental benefits, formulary and cost-sharing structures, service-area expansion, and specialized plan offerings while balancing member value, growth, competitiveness, regulation, and margin targets.
Oversee actuarial valuation and pricing for Essence Healthcare plan offerings, including unpaid claim liabilities (IBNR), premium deficiency reserves, and risk-sharing settlements.
Enhance risk management, internal controls, and pricing policies and procedures in accordance with statutory accounting principles, NAIC guidelines, and CMS MLR standards.
Lead the development, modeling, review, documentation, certification, and HPMS submission of annual Medicare Advantage Part C and Part D bids, including quality controls and bid-to-actual monitoring.
Interpret and model the financial impacts of CMS notices, rate announcements, county benchmark adjustments, and risk adjustment model changes; align risk-score forecasts with bid assumptions.
Ensure actuarial financial statement items and regulatory settlements are established in accordance with applicable actuarial, regulatory, and accounting guidance.
Oversee processes and analyses that support compliance and audit readiness for CMS financial exams, RADV audits, and RAPS/EDPS encounter data reviews.
Develop continuous-improvement initiatives, tools, and actuarial methods, and incorporate Star Ratings financial implications into long-term plans and multi-year bid curves.
Build cross-functional partnerships and advise teams on data, analyses, and strategically sound business opportunities.
Lead the company actuarial program, including study time and exam-related guidelines to support credentialing among junior and mid-level actuarial staff.
Provide pricing analysis, reports, and dashboards, including bid-to-actual variance analyses, unit-cost trends, and risk-score trajectory tracking.

Benefits

Medical, vision, and dental plans
Tax-advantaged savings accounts (FSA and HSA)
Life insurance and disability insurance
Paid time off, sick time, paid leave, volunteer days, and wellness days
Employee Assistance Program
401(k) with company match
Employee Resource Groups
Employee Discount Program
Learning and Development Opportunities
Some roles may qualify for a performance-based incentive and/or equity, subject to eligibility