Actuary, Risk and Compliance

Humana Inc; Charleston (WV); On-site; USD 129,000 - 178,000; Full time

Benefits offered by this job

Remote position

Job summary

Humana Inc. is seeking a Lead Actuary, Risk and Compliance to lead actuarial risk management for Medicare Advantage and PDP bids. You will oversee actuaries and staff, identify risks, estimate financial impact, and develop controls to minimize compliance risk across the bid filing process.

The role requires collaboration with pricing actuaries, participation in CMS audits, and driving process improvements. This is a remote position with occasional travel to Humana offices; 40-hour weeks and a

Qualifications

• Bachelor's degree in a related field.
• 8+ years of actuarial experience.
• 2+ years of project leadership experience.
• ASA or FSA credential.
• MAAA membership.
• Excellent written and verbal communication.

Responsibilities

• Lead the risk assessment for Medicare bids and CMS compliance.
• Oversee actuarial staff and collaborate with pricing actuaries.
• Develop controls and process improvements to minimize compliance risk.
• Support CMS audits and participate in regulatory reviews.

Skills

Technical actuarial experience

Project leadership

Communication skills

CMS/regulatory knowledge

Bid filing experience

Education

Bachelor's degree

ASA or FSA credential

MAAA membership

Job description

Become a part of our caring community

The Lead Actuary, Risk and Compliance is responsible for the overall management and oversight of actuaries and/or support staff where activities are concerned with identifying and managing risks. You will identify and analyze potential risks and estimates the potential financial consequences, develop and recommend controls and cost-effective approaches to minimize risks. You will work on problems of diverse scope and complexity ranging from moderate to substantial.

The Lead Actuary, Risk and Compliance will report to the Director, Actuarial Risk & Compliance. In this specific role, you will be part of a team tasked with assessment of risk, opportunities, and mitigation strategies to assure the compliant submission of bids to support Humana's pricing and product development of Medicare Advantage and Prescription Drug Plans that positively impact the financial performance of Humana. In particular, this position is responsible for ensuring compliance with CMS requirements related to Total Beneficiary Cost. This includes maintaining the internal version of the Out-of-Pocket Cost (OOPC) Model published by CMS, obtaining needed inputs from business partners, running and interpreting the model’s results, and partnering with the pricing actuaries to find solutions to resolving test failures.

In addition, as a member of the Compliance team this role is responsible for:

• Supporting Humana’s MA-PD and PDP bid filings by ensuring appropriate interpretation and implementation of CMS guidance, and implementation and execution of review standards and controls to minimize compliance risk associated with the bid filing

• Participate in CMS audits and reviews related to Humana’s Medicare bids.

• Create and maintain process improvements to bid filings to continually improve Humana's ability to file compliant bids.

This position comes with the opportunity of leading a direct report.

The Lead Actuary, Risk and Compliance assesses and communicates information regarding actuarial/business risks across the organization. You will provide peer review and counsel on a wide variety of company, industry, and regulatory practices. Activities may include monitoring developments in actuarial techniques, and researching laws and regulations applicable to actuarial science and insurance operations. You will advise executives to develop functional strategies (often segment specific) on matters of significance.

Use your skills to make an impact

Required Qualifications

• Bachelor's degree

• 8 or more years of technical experience

• 2 or more years of project leadership experience

• Associate or Fellow in the Society of Actuaries (ASA or FSA)

• Member of the American Academy of Actuaries (MAAA)

• Demonstrated ability to articulate ideas effectively in both written and oral forms

Preferred Qualifications

• Medicare Advantage experience

• Ability to manage large projects involving actuarial and non-actuarial staff

Additional Information

This is a remote position.

Work at Home Requirements: To ensure Home or Hybrid Home/Office employees’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria: At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested. In certain roles, the minimum recommended internet speed required by Humana may not be sufficient for business needs. Humana reserves the right to require associates to upgrade their internet service if necessary. Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.

Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.

Scheduled Weekly Hours

40

Pay Range

The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.

$129,300 - $177,800 per year

This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.

Description of Benefits

Humana, Inc. and its affiliated subsidiaries (collectively, "Humana") offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.

Application Deadline: 09-22-2026

About us

About Humana: Humana Inc. (NYSE: HUM) is a leading U.S. healthcare company. Through our Humana insurance services and our CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health - delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare and Medicaid, families, individuals, military service personnel, and communities at large. Learn more about what we offer atHumana.comand atCenterWell.com.

Equal Opportunity Employer

It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.

Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our https://www.humana.com/legal/accessibility-resources?source=Humana_Website.