VP, Medicare Advantage – Chief Actuary

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🇺🇸 United States – Remote

💵 $175.3k - $249.1k / year

⏰ Full Time

🔴 Lead

📊 Actuary

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Lumeris

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1001 - 5000 employees

🏥 Healthcare

⚕️ Healthcare Insurance

☁️ SaaS

Healthcare • Healthcare Insurance • SaaS

Lumeris is a company focused on providing value-based care solutions within the healthcare industry. With over a decade of leadership in this field, Lumeris partners with health systems to improve patient outcomes and drive financial success through tech-enabled solutions. Their platform supports population health management, clinical delivery transformation, and payer contracting, offering comprehensive solutions for acute, post-acute, and high-risk patient management. Lumeris is recognized for creating significant cost savings and achieving excellent patient outcomes, including a 5-star CMS rating for its Medicare Advantage Prescription Drug Plan.

📋 Description

• Develop, implement, and guide strategic direction for the Medicare Advantage actuarial function • Oversee, coach, mentor, motivate, support, and develop a cross-functional actuarial and healthcare economics team • Manage goal setting, career development, upskilling, resource allocation, staffing, budgeting, and succession planning • Provide executive business intelligence on MLR, claims trends, membership and revenue dynamics, profitability, risk scores, and regulatory revenue shifts • Serve as primary actuarial authority for Medicare Advantage product strategy and pricing • Evaluate plan benefit packages, supplemental benefits, formularies, cost-sharing structures, service-area expansion, and specialized plan offerings • Oversee actuarial valuation, pricing, unpaid claim liabilities, IBNR, premium deficiency reserves, and risk-sharing settlements • Lead end-to-end annual Medicare Advantage Part C and Part D bid development, modeling, certification, and HPMS submission • Govern assumptions, scenario testing, quality controls, executive review, and bid-to-actual monitoring • Interpret CMS policy and model financial impacts of rate announcements, benchmark adjustments, and risk adjustment changes • Ensure actuarial financial statement items comply with CMS, actuarial, regulatory, and accounting guidance • Maintain governance, quality assurance, compliance, and audit readiness for CMS exams, RADV audits, and encounter data reviews • Develop innovative actuarial methodologies and incorporate Star Ratings economics into strategic plans and bid curves • Build cross-functional partnerships and align actuarial strategy with value-based care opportunities • Lead the company actuarial program and support credentialing of junior and mid-level actuarial staff • Produce pricing analyses, reports, executive dashboards, bid-to-actual variance analyses, cost trends, and risk score tracking

🎯 Requirements

• Bachelor’s degree in Actuarial Science, Mathematics, Statistics, Economics, or related quantitative field • Fellow of the Society of Actuaries (FSA) and Member of the American Academy of Actuaries (MAAA) in good standing • Meet qualification standards to issue Statements of Actuarial Opinion and CMS Medicare Advantage Part C and Part D Actuarial Certifications • 15+ years of health actuarial experience • At least 7–10 years of direct, senior leadership experience in Medicare Advantage bid preparation, Part C/Part D pricing development, reserving, risk adjustment, and CMS health plan financial management • Significant executive leadership within a Medicare Advantage organization, HMO, or national managed care carrier • 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 direct subsidy/formulary economics, Star Ratings financial mechanics, and statutory IBNR reserving • Excellent financial knowledge and understanding of healthcare economics, actuarial and accounting practices, value-based care delivery, capitation, two-sided risk sharing, and Medicare Advantage statutory balance sheet management • Proven ability to develop, coach, mentor, and empower cross-functional teams • Experience developing pricing strategies and plans for new products and innovative services, including specialized MA plans and supplemental benefit packages • Ability to collaborate across teams and organizational levels under strict statutory timelines • Experience partnering with sales and growth teams on AEP targets, geographic service area expansions, and competitive 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 workflow during high-pressure bid cycles and regulatory filing windows • Ability to work with integrity and uphold organizational values • Excellent written and verbal communication skills • Authorized to work in the United States; visa sponsorship unavailable

🏖️ Benefits

• Medical, Vision and Dental Plans • Tax-Advantage Savings Accounts (FSA & HSA) • Life Insurance and Disability Insurance • Paid Time Off (PTO, Sick Time, Paid Leave, Volunteer & Wellness Days) • Employee Assistance Program • 401k with company match • Employee Resource Groups • Employee Discount Program • Learning and Development Opportunities • Performance-based incentive and/or equity may be available depending on the position • Approved COVID-19 vaccination coverage/requirement for applicable member-facing roles

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