Health Actuary

Antidote Health is a tech‑driven health insurance company on a mission to make healthcare easy, accessible, and more affordable. We’re rethinking how healthcare works—using technology to remove the friction, complexity, and delays that define the traditional system. Instead of navigating paperwork, long waits, and disconnected experiences, we’re building a simpler, more connected way for people to get care.

Our platform combines health coverage, virtual care, and a modern member experience into one seamless system designed to help people actually use their benefits.

We offer Affordable Care Act (ACA) health plans in Arizona and Ohio, and we’re growing quickly. We’re building a company focused on solving real problems—with real impact on people’s lives.

You are responsible as the steward of the Antidote health plan’s economic system, translating actuarial analysis into enterprise decisions that improve financial sustainability, member outcomes, and organizational performance. Rather than optimizing isolated metrics, the role identifies how interactions across pricing, care delivery, benefit design, provider incentives, and population health collectively determine Medical Loss Ratio (MLR) and long‑term value creation. The role is reporting to the General Manager of the HMO.

Medical Loss Ratio (MLR) System Leadership

• Monitor utilization, unit cost, premium sufficiency, emerging trends, catastrophic claims, risk adjustment transfers, and seasonality.
• Identify the underlying system interactions driving MLR performance rather than treating cost trends as isolated events.
• Distinguish between symptoms (rising costs) and structural causes (benefit design, provider incentives, member behavior, care access, operational workflows).
• Lead cross‑functional initiatives involving Clinical, Network, Product, Finance, Operations, and Care Management to improve overall economic performance.

Population Health Economics

• Analyze membership composition, morbidity, provider contracts, and health risk distributions.
• Identify opportunities where improved clinical outcomes reduce long‑term medical costs.
• Recommend Quality Improvement Activities (QIA) that generate measurable improvements in both member health and financial performance.
• Evaluate how interventions in one area influence performance throughout the organization.

Integrated Actuarial & Financial Strategy

• Evaluate pricing strategies, benefit designs, network configurations, and risk adjustment scenarios as interconnected components of the overall health plan.
• Model how product, provider, regulatory, and operational decisions interact over time.
• Assess long‑term sustainability instead of optimizing short‑term financial metrics.
• Support actuarial certifications and regulatory filings while ensuring consistency with the organization’s broader strategic objectives.

Enterprise Systems Thinking

• Translate actuarial insights into actionable business strategy.
• Develop models that capture interactions across finance, clinical care, operations, provider networks, and member behavior.
• Identify leverage points where relatively small interventions can improve multiple enterprise outcomes simultaneously.
• Help executive leadership understand tradeoffs between cost, quality, growth, risk, and member experience.

• 5–15 years of experience in health insurance, healthcare economics, actuarial analysis, management consulting, or population health.
• Experience supporting ACA Marketplace, Medicare Advantage, Medicaid Managed Care, or commercial health insurance products.
• Strong analytical and quantitative skills, with proficiency in SQL, Python
• Demonstrated ability to influence enterprise decisions through data‑driven analysis, moving beyond reporting to strategic problem solving.
• Experience partnering across Finance, Clinical, Network Management, Product, Care Management, and Operations.
• Proven ability to translate complex analytical findings into clear, actionable recommendations for executive leadership.
• Demonstrated ability to work independently, identify opportunities, initiate analyses, educate cross‑functional teams, lead projects from concept…