Director, Actuarial Services

Smith Hanley Associates; United States; On-site; USD 120,000 - 160,000; Full time

Job summary

A growing health plan is seeking a Director, Actuary to lead and manage actuarial initiatives within a remote work environment. The ideal candidate will have over 8 years of experience in health insurance, providing strategic actuarial guidance, managing staff, and ensuring compliance with regulations. A strong background in data analysis and actuarial software is required. The position offers the chance to contribute significantly to business expansion in health care.

Qualifications

• 8+ years of progressively responsible actuarial experience in health insurance or managed care.
• Experience with Medicare and Medicaid programs.
• Strong understanding of health insurance markets and regulations.

Responsibilities

• Lead and manage actuarial initiatives across the organization.
• Serve as an internal actuarial consultant.
• Ensure compliance with federal and state rate filing requirements.

Skills

Strategic Consulting

Data Analytics

Risk Quantification

Analytical Skills

Communication Skills

Education

Bachelor’s degree in Actuarial Science, Mathematics, Statistics, Economics, or related field

Master’s degree

Tools

Data analysis tools

Actuarial software

Job description

Job Title: Director, Actuary (Remote)

Department: Actuarial Services
Location: Remote (U.S. Based)

Overview:
A growing health plan is seeking a Director, Actuary to lead and manage actuarial initiatives across the organization. This fully remote role offers the opportunity to work with a leading health care organization, providing strategic actuarial guidance across multiple business areas. The Director will ensure excellence in actuarial services, including pricing, reserving, product development, financial forecasting, and regulatory compliance.

Key Responsibilities:

• Strategic Consulting: Serve as an internal actuarial consultant across business units.
• Provide expert guidance in areas such as Incurred But Not Reported (IBNR) claims, data analytics, and risk quantification.
• Actuarial Management: Supervise and develop actuarial staff to meet departmental and corporate objectives.
• Ensure the quality, accuracy, and timeliness of actuarial work products.
• Reserving & Forecasting: Partner with Financial Reporting to calculate reserves for IBNR claims, active claims, and premium deficiency reserves.
• Deliver financial forecasts and projections to support executive decision-making.
• Analyze the financial impact of new products and benefit changes.
• Establish pricing strategies, tools, and methodologies that align with strategic goals and ensure sustainable profitability.
• Underwriting & Risk Management: Collaborate with underwriting to develop pricing tools and support sales efforts.
• Enhance underwriting accuracy through robust risk assessment tools and training.
• Provider Contracting: Evaluate and report on the financial implications of provider agreements and contract modifications.
• Regulatory Compliance: Ensure compliance with federal and state rate filing requirements.
• Support statutory filings, including the Annual Statement of Actuarial Opinion.
• Business Expansion: Support the organization in exploring and entering new markets such as Stop Loss Insurance and Workers’ Compensation.

Qualifications:

• Bachelor’s degree in Actuarial Science, Mathematics, Statistics, Economics, or a related field required; Master’s degree preferred.
• Minimum of 8 years of progressively responsible actuarial experience in health insurance or managed care.
• Experience in both commercial and government health programs (e.g., Medicare, Medicaid).
• Strong understanding of health insurance markets and regulations, including the Medicare Modernization Act (MMA).
• Proficiency in data analysis tools, relational databases, and actuarial software.
• Exceptional analytical, problem-solving, and communication skills.

Certifications:

• ASA or FSA designation from the Society of Actuaries required.
• Membership in the American Academy of Actuaries required.
• Must meet applicable background check requirements.