VP, Medicare Advantage Chief Actuary

Your Future is our Future

At Lumeris,we believe that our greatest achievements are made possible by the talent and commitment of our team members. That's why we are actively seeking talented and collaborative individuals who are passionate about making a difference in the healthcare industry. Join us today as we strive to create a system of care that every doctor wants for their own family and become part of a community that values its people and empowers you to make an impact.

We're excited to consider every qualified candidate authorized to work in the United States, although we are unable to sponsor visas for this role at this time.

VP, Medicare Advantage Chief Actuary

Provides oversight, strategic direction, process improvements, and best practices for the department. Responsible for all actuarial and underwriting/pricing functions in support of Essence Healthcare’s Medicare Advantage plan operations. Partnering closely with the leaders of Risk Adjustment, Pharmacy, Health Plan Product, and Stars Strategy, this role delivers forward-thinking strategies and provides business direction regarding actuarial rate setting, pricing, annual CMS Part C and Part D bid submissions, risk adjustment factor forecasting, premium development, valuation and statutory reserve setting (including IBNR), financial risk management, product development, and performance analytics to maintain long-term financial sustainability, market competitiveness, and high Star Ratings performance.

Primary Responsibilities:

• Strategic Leadership & Talent Development: Develops, implements, and guides strategic direction for the Medicare Advantage actuarial function. Oversees, coaches, mentors, motivates, supports, and develops a cross-functional team, building specialized internal capabilities in Medicare Advantage pricing, Part D benefit economics, reserving, risk adjustment, healthcare economics, and advanced healthcare analytics. Oversees goal setting/review, regular guidance and 1-1 check-ins, career development/planning, upskilling, resource allocation, staffing, budget creation/management, succession planning, and other People & Culture programs/activities as needed.
  
  Fosters accountability, collaboration, and innovation to ensure organizational goals are met.
• Executive Business Intelligence & Plan Performance: Oversees and supports cross-functional alignment to ensure the best possible business intelligence and understanding of company financials in communications to executive team and the Essence Healthcare Board of Directors; delivers clear visibility into emerging Medical Loss Ratios (MLR), emerging claims trends, membership and revenue dynamics, member cohort profitability, risk score performance, and regulatory revenue shifts.
• MA Product Design & Pricing Architecture: Serves as the primary actuarial authority for Medicare Advantage product strategy and pricing. Partners with Health Plan Product, Clinical, Pharmacy, Network, Finance, and Market Growth leaders to evaluate Plan Benefit Packages (PBPs), supplemental benefits (e.g., dental, vision, hearing, OTC allowances), formulary and cost-sharing structures, service-area expansion, and specialized plan offerings. Balances member value, growth objective, competitive positioning, regulatory requirements, while achieving margin targets.
• Valuation, Reserving &
  
  Risk Management:
  
  Responsible for actuarial valuation for financial reporting functions. Oversees pricing and valuation for all Essence Healthcare plan offerings. Directs the estimation and review of unpaid claim liabilities (IBNR), premium deficiency reserves, and risk-sharing settlements in strict accordance with statutory accounting principles (SAP), NAIC guidelines, and…