Medicare Advantage Pricing Actuary

Job Summary

Leading the annual Medicare Advantage bidding process, the full-time remote Medicare Advantage Pricing Actuary will direct strategy, modeling, and execution while ensuring compliance with CMS regulations and collaborating across various teams.

Key responsibilities

• Direct and oversee the end-to-end development, modeling, and submission of annual Medicare Advantage bids, ensuring compliance with CMS guidelines
• Partner with product and clinical leaders to design competitive benefit packages and establish core actuarial bid assumptions
• Build and maintain scalable bid pricing models while performing scenario testing and sensitivity analyses to assess financial impacts of regulatory changes

Required qualifications

• 8+ years of progressive healthcare actuarial experience, with at least 5+ years focused on Medicare Advantage bid pricing and CMS bid submission
• Demonstrated ability to manage complex, time-sensitive projects with high-stakes regulatory deadlines
• Advanced proficiency in actuarial modeling and financial modeling tools such as SQL, Python, R, SAS, or advanced Excel
• Thorough understanding of Medicare Advantage pricing mechanics and CMS risk adjustment models
• Exceptional interpersonal skills with a proven track record of effective cross-functional collaboration