VP-Chief Actuary-Presbyterian Health Plan

Presbyterian Healthcare Services; Albuquerque (NM); On-site; USD 180,000 - 280,000; Full time

Job summary

A healthcare provider in Albuquerque is seeking a Chief Actuary responsible for overseeing actuarial services, pricing, and risk management. The ideal candidate will contribute to financial soundness, ensuring compliance and providing strategic insight to leadership. Responsibilities include leading rate negotiations, evaluating Medicaid rates, and developing actuarial talent. Strong actuarial expertise and a bachelor's degree in a related field are required. This role is pivotal in supporting both government and commercial lines of business.

Qualifications

• Experience in actuarial services and risk management.
• Strong analytical skills with a focus on Medicaid regulations.
• Proven ability to collaborate with government agencies.
• Provide strategic actuarial insights to executive leadership.
• Develop actuarial talent and standards.

Responsibilities

• Lead pricing, underwriting, and actuarial services.
• Ensure actuarial governance and compliance.
• Develop and mentor actuarial talent.
• Support rate negotiations and data submissions to state and CMS.
• Analyze risk adjustment models and eligibility churn impacts.

Skills

Actuarial expertise

Underwriting knowledge

Forecasting

Regulatory compliance

Strategic insight

Education

Bachelor's degree in Actuarial Science, Mathematics, or related field

Job description

Location Address

9521 San Mateo NE Albuquerque, NM 87113-2237

Summary

The Chief Actuary is the senior leader responsible for actuarial services, underwriting, pricing, reserving, forecasting, and insurance risk management. This role contributes to the financial soundness of the health plan, provides strategic insight to executive leadership, and oversees all actuarial and underwriting functions supporting government and commercial lines of business. The Chief Actuary serves as the Appointed Actuary and is accountable for regulatory compliance, actuarial governance, and the development of actuarial talent.

Job Description

Product and Pricing Strategy

• Evaluate and Promote Medicaid Rate Adequacy & State Partnership
• Oversee evaluation of capitation rate assumptions.
• Partner directly with the state Medicaid agency to ensure assumptions are reasonable, risk is managed, and rates are actuarially sound.
• Support rate negotiations and data submissions to the state and CMS.
• Analyze the impact of risk adjustment models, acuity shifts, redeterminations and eligibility churn, directed payments and supplemental payment programs, changes in