Director, Actuarial & Performance Guarantees

Twin Health; New York (NY); Remote; USD 205,000 - 215,000; Full time

Benefits offered by this job

Unlimited vacation

Parental leave

Health insurance

401k

Job summary

Twin Health is hiring a Director, Actuarial & Performance Guarantees to own the guarantees on Twin’s outcomes and to shape client deals from design to settlement. You’ll lead the actuarial voice in partner contracting and oversee measurement, reconciliation, and revenue recognition with Accounting and Finance.

Reporting into Value, Access & Pricing leadership, you’ll collaborate with senior leadership, sales, clinical, and data teams to ensure robust, defensible guarantees and scalable actuarial

Qualifications

• 8+ years of health actuarial experience
• 3+ years designing, pricing, or reconciling performance guarantees
• Direct Medicare Advantage actuarial experience required
• Experience shaping deal structures and negotiating actuarial terms
• Familiarity with ASC 606 variable consideration
• Strong SQL and data analysis skills

Responsibilities

• Shape deal structure with sales and pricing for attractiveness and actuarial soundness
• Validate client business cases, savings projections, and ROI models
• Lead performance guarantee design including payout mechanics and measurement windows
• Price guarantee risk and link terms to pricing and deals
• Serve as actuarial lead in contracting and defend methodologies
• Oversee guarantee execution from data inputs through settlement and disputes
• Collaborate with Accounting on revenue recognition and accruals
• Document actuarial methods and maintain audit trails
• Collaborate with cross-functional teams to ensure measurable guarantees
• Build and grow the actuarial function with mentees and processes

Skills

SQL

Python/R

Actuarial analysis

Contracting & negotiation

Communication

Education

Fellow of the Society of Actuaries (FSA)

MAAA

Tools

Data warehouse

Statistical programming (R/Python)

Job description

Twin Health

At Twin Health, we empower people to improve and prevent chronic metabolic diseases, like type 2 diabetes and obesity, with a new standard of care. Twin Health is the only company applying AI Digital Twin technology exclusively toward metabolic health.

At Twin Health, we empower people to improve and prevent chronic metabolic diseases, like type 2 diabetes and obesity, with a new standard of care. Twin Health is the only company applying AI Digital Twin technology exclusively toward metabolic health.

We start by building a dynamic model of each person’s metabolism — drawing on thousands of data points from CGMs, smartwatches, and meal logs — that maps their personal path to better health. Guided by a dedicated clinical care team, our members have lowered their A1C below the diabetes range, achieved lasting weight loss, and reduced or even eliminated medications, all while living healthier, happier lives.

Working here

Our team at Twin Health is passionate, talented, and united by a shared purpose: to improve the metabolic health and happiness of our members. We believe in empowering every Twin to make a meaningful impact for our members, our clients, and each other, while enjoying a supportive, collaborative work environment.

Twin has been recognized not only for our innovation but also for our culture, including: Innovator of the Year by the Employer Health Innovation Roundtable (EHIR), selected to CB Insights’ Digital Health 150, and named one of Newsweek’s Top Most Loved Workplace® .

With more than $100 million raised in recent funding, including a $53 million Series E round in 2025 led by Maj Invest, and a $50 million investment in 2023 led by Temasek, Twin is scaling rapidly across the U.S. and globally. Backed by leading venture firms like ICONIQ Growth, Sequoia, Sofina, Temasek, and Peak XV, we are building the most impactful digital health company in the world.

Join us as we reinvent the standard of care in metabolic health.

Opportunity

This role is a unique opportunity to own how Twin puts its outcomes on the line. Twin stands behind its results with performance guarantees, and you’ll be the credentialed actuarial owner of those commitments from first design through final settlement.

As Director, Actuarial & Performance Guarantees, you’ll help shape Twin’s deals from the start, validating the business case we present to clients. You’ll lead the development of Twin’s performance guarantees and serve as the actuarial voice in partner contracting. You’ll also oversee measurement and settlement of every guarantee in market. You’ll partner closely with Accounting and Finance to ensure the company forecasts guarantee outcomes accurately and recognizes revenue appropriately. This is a highly visible role reporting into Value, Access & Pricing leadership, working directly with senior leadership, sales, finance, clinical, and data teams. Your work will shape how health plans, employers, and health systems evaluate Twin.

Responsibilities

• Shape deals from the start by partnering with sales and pricing on deal structure, fees at risk, and guarantee terms, so that each opportunity is commercially attractive and actuarially sound before it reaches contracting, including structuring arrangements that fit Medicare Advantage plan economics, bid cycles, and quality programs.
• Validate client business cases by reviewing the savings projections, ROI models, and population assumptions Twin presents to prospective clients. You’ll make sure every claim is defensible and consistent with how Twin measures and guarantees results.
• Lead performance guarantee design, including savings and clinical guarantee structures, measurement windows, comparison populations, statistical credibility thresholds, and payout mechanics. You’ll balance what partners find compelling against the risk Twin can responsibly hold.
• Price guarantee risk by modeling expected payout distributions and fees at risk under a range of scenarios, and by linking guarantee terms to Twin’s pricing and deal structures.
• Serve as the actuarial lead in contracting, owning guarantee terms in negotiations, reviewing contract language, and defending Twin’s methodology with payer actuaries, benefits consultants, and partner analytics teams.
• Own guarantee execution from data inputs through measurement, reconciliation, settlement, and resolution of disputes with partners. You’ll make sure every result can be reproduced and defended.
• Partner with Accounting and Finance on forecasting by developing expected-payout estimates for variable consideration under ASC 606, supporting quarterly accruals and true-ups, and ensuring revenue forecasts reflect realistic guarantee performance.
• Govern actuarial methodology by documenting and validating savings and outcome methods, producing actuarial memos consistent with relevant Actuarial Standards of Practice, and maintaining a clear audit trail for every guarantee, ensuring consistency from proposal to contract to settlement.
• Collaborate across the business, working with sales, clinical, and data engineering teams to ensure guarantee definitions are operational, measurable, and supported by Twin’s claims data model.
• Build the actuarial function by establishing processes, mentoring analysts, and shaping how the team grows as Twin’s book of guaranteed business scales.
• Other duties as assigned

Qualifications

• Credentials: Fellow of the Society of Actuaries (FSA) and Member of the American Academy of Actuaries (MAAA) required.
• Background: 8+ years of health actuarial experience, including 3+ years designing, pricing, or reconciling performance guarantees, value-based contracts, or vendor ROI arrangements, whether at a payer, consulting firm, or health services company.
• Medicare Advantage Expertise: Direct Medicare Advantage actuarial experience is required. That includes a working knowledge of the MA bid process, CMS-HCC risk adjustment, Star Ratings, medical loss ratio requirements, and supplemental benefits, and of how a vendor program affects each from the plan’s perspective.
• Deal & Contracting Expertise: Proven experience shaping deal structures and negotiating actuarial terms directly with health plans, employers, or their consultants, and defending business cases and methodology under external review.
• Financial Acumen: Experience partnering with Accounting on revenue recognition, accruals, or reserving for at‑risk or contingent arrangements. Familiarity with ASC 606 variable consideration is strongly preferred.
• Methodological Rigor: Strong grounding in claims-based savings measurement, risk adjustment, and comparison group methods, including difference-in-differences and matched cohort designs, with an understanding of their limitations.
• Technical Proficiency: Advanced skills in SQL and a statistical programming language (R or Python), with comfort working directly in a modern data warehouse.
• Communication: Ability to translate complex actuarial findings into clear recommendations for senior leadership, sales teams, and external partners.
• Passion: Twin’s purpose to transform lives by empowering people to reverse, prevent and improve chronic metabolic diseases excites you.
• This remote opportunity based out of the U.S. Applicants must be authorized to work for any employer in the U.S. We are unable to sponsor or take over sponsorship of an employment Visa at this time.

Compensation And Benefits

The compensation range for this position is $205,000 - $215,000 annually. This position is bonus eligible.

Twin has an ambitious vision to empower people to live healthier and happier lives, and to achieve this purpose, we need the very best people to enhance our cutting-edge technology and medical science, deliver the best possible care, and turn our passion into value for our members, partners and investors. We are committed to delivering an outstanding culture and experience for every Twin employee through a company based on the values of passion, talent, and trust. We offer comprehensive benefits and perks in line with these principles, as well as a high level of flexibility for every Twin

• A competitive compensation package in line with leading technology companies
• A remote and accomplished global team
• Opportunity for equity participation
• Unlimited vacation with manager approval
• 16 weeks of 100% paid parental leave for delivering parents; 8 weeks of 100% paid parental leave for non-delivering parents
• 100% Employer sponsored healthcare, dental, and vision for you, and 80% coverage for your family; Health Savings Account and Flexible Spending Account options
• 401k retirement savings plan

Salary range for US jobs

US Salary Range

$205,000—$215,000 USD