Director, Actuarial

Sentara Healthcare Inc; Norfolk (VA); On-site; USD 120,000 - 150,000; Full time

Job summary

Sentara Healthcare Inc in Norfolk, Virginia is seeking a Director, Actuarial for Government Programs to lead actuarial pricing and provide financial insights across Medicare and Medicaid initiatives. This role requires a strong managerial background with over 7 years of actuarial experience, and a Bachelor's Degree is required.

The ideal candidate will collaborate across teams to ensure market-competitive products and foster innovation within the actuarial function.

Qualifications

• Minimum 5 years management experience.
• At least 7 years of actuarial experience.

Responsibilities

• Lead end-to-end pricing for Medicare Advantage and Medicaid.
• Translate pricing assumptions into financial projections.
• Ensure compliance with CMS and Medicaid requirements.
• Partner on benefit design and product strategy.
• Lead a team of actuaries and analysts.
• Contribute to enterprise planning and budgeting.

Skills

Actuarial pricing

Financial performance insights

Strategic analytics

Team leadership

Cross-functional collaboration

Education

Bachelor's Degree

Job description

The Director, Actuarial – Government Programs will lead actuarial pricing, financial performance insights, and strategic analytics across SHP’s Medicare and Medicaid lines of business. This role is critical to ensuring market-competitive, compliant, and financially sustainable products while translating actuarial insights into actionable business decisions.

This leader will operate in a highly matrixed environment, partnering closely with Finance, Product, Network, Risk Adjustment, and Clinical teams to drive enterprise value and support SHP’s growth strategy.

Core Responsibilities

1. Government Programs Pricing & Financial Management

• Lead end-to-end pricing for Medicare Advantage, Medicaid, and related government programs
• Develop and maintain actuarial assumptions, methodologies, and pricing models
• Ensure rate adequacy, competitiveness, and alignment with enterprise financial targets
• Oversee bid development, rate filings, and regulatory submissions

2. Forecasting & Performance Insights

• Translate pricing assumptions into forward-looking financial projections and scenarios
• Monitor emerging experience vs. pricing assumptions and identify key drivers of variance
• Provide actionable insights to improve margin, membership growth, and cost management

3. Regulatory & Compliance Leadership

• Ensure compliance with CMS, state Medicaid agencies, and insurance department requirements
• Support actuarial certifications, rate filings, and audit readiness
• Interface with regulators and external actuarial partners as needed

4. Strategic Partnership & Cross-Functional Leadership

• Partner with Product, Network/Provider Contracting, and Clinical teams on:
  • Benefit design and product strategy
  • Value-based care and provider reimbursement models
  • Cost of care and utilization management strategies
• Align actuarial assumptions with operational and market realities across the enterprise

5. Team Leadership & Talent Development

• Lead and develop a high-performing team of actuaries and analysts
• Establish clear priorities, governance, and quality standards for actuarial work products
• Foster a culture of innovation, continuous improvement, and accountability

6. Enterprise Contribution & Thought Leadership

• Contribute to enterprise planning, budgeting, and long-term strategy
• Present insights and recommendations to senior leadership in a clear, actionable manner
• Identify opportunities for automation, analytics advancement, and process optimization

Qualifications

• Bachelor's Degree Required.
• 5 years Management experience.
• 7 years Actuarial experience.