Pricing Actuary – Medicare Advantage

🔥 16 hours ago

🇺🇸 United States – Remote

💵 $175k - $250k / year

⏰ Full Time

🟠 Senior

🔴 Lead

📊 Actuary

👻 Ghost score 0%

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Devoted Health

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 2017

🏥 Healthcare

⚕️ Healthcare Insurance

🧘 Wellness

Healthcare • Healthcare Insurance • Wellness

Devoted Health is a healthcare company that offers Medicare Advantage plans designed to provide comprehensive health coverage with added benefits like dental, eyewear, gym memberships, and prescription drugs at competitive rates. The company emphasizes member support and service, ensuring that clients can easily navigate their benefits and access needed healthcare services. Devoted Health is committed to helping customers save money and enhance their health and wellness through a complete package of benefits and support.

📋 Description

• Direct and oversee the end-to-end development, modeling, and submission of annual Medicare Advantage Part C and Part D bids • Ensure compliance with CMS guidelines and adherence to statutory deadlines • Partner with product, clinical, and local market leaders to design competitive benefit packages • Establish, defend, and document actuarial bid assumptions • Build, refine, and maintain scalable bid pricing models • Perform scenario testing and sensitivity analyses for CMS payment policy changes, risk model updates, benchmark shifts, and competitive dynamics • Interpret CMS Call Letters, Bid Instructions, and Rate Announcements and translate changes into modeling adjustments and executive guidance • Collaborate with Finance, Healthcare Economics, Clinical Operations, and Network Management • Partner with data engineering and analytics teams to ensure claims, enrollment, and risk adjustment data quality • Prepare executive-level presentations on bid strategy, financial returns, and risk profiles for leadership, board members, and regulatory reviewers

🎯 Requirements

• 8+ years of progressive healthcare actuarial experience • At least 5+ years of deep, direct focus on Medicare Advantage bid pricing, plan design, and CMS bid submission • Demonstrated ability to consistently drive complex, time-sensitive projects to completion on schedule • Advanced proficiency in actuarial modeling, claims data extraction, and financial modeling tools such as SQL, Python, R, SAS, or advanced Excel modeling • Thorough understanding of Medicare Advantage pricing mechanics, including Part D direct subsidy/benefit design, CMS risk adjustment models (CMS-HCC, RxHCC), Star Ratings financial impacts, and benchmark calculations • Exceptional interpersonal skills and proven cross-functional collaboration experience • Actuarial designations ASA, FSA, or MAAA are optional; equivalent practical mastery and bid leadership track record are recognized • Experience interfacing with reserving, underwriting, risk adjustment operations, or medical economics functions • Comfort operating in a fast-paced, high-growth environment

🏖️ Benefits

• Employer sponsored health, dental and vision plan with low or no premium • Generous paid time off • $100 monthly mobile or internet stipend • Stock options for all employees • Bonus eligibility for all roles excluding Director and above • Parental leave program • 401K program