Pricing Actuary-Medicare Advantage

Devoted Health; Waltham (MA); A distancia; USD 175.000 - 250.000; Jornada completa

Ventajas ofrecidas por este puesto de trabajo

Health, dental & vision

Generous PTO

Monthly mobile/internet stipend

Stock options

Bonus eligibility

Parental leave

401K plan

And more...

Descripción de la vacante

Devoted Health is seeking a Pricing Actuary to lead the end-to-end Medicare Advantage (Part C and D) bid process. You will direct modeling, pricing strategy, and submission while ensuring CMS compliance and tight deadlines.

You will collaborate with product, clinical, finance, and leadership to design competitive packages, defend core assumptions, and provide executive-level insights on risk and returns.

Formación

• Core MA actuarial experience (8+ years) with focus on bid pricing and CMS bid submission.
• Proven track record delivering deadlines under regulatory constraints.
• Advanced modeling and data capabilities using SQL, Python, R, SAS, and Excel.

Responsabilidades

• Lead end-to-end MA bid strategy, modeling, and submission in compliance with CMS rules.
• Collaborate with product, clinical, finance, and leadership to price benefits and assess trade-offs.
• Develop and defend bid assumptions including utilization, unit costs, risk factors, and margins.
• Build and maintain scalable bid pricing models with governance and repeatable execution.
• Perform scenario analyses to assess CMS policy changes and market dynamics.
• Translate CMS instructions into actionable modeling changes and strategic guidance.
• Coordinate across Finance, Healthcare Economics, Clinical Ops, and Network Management.
• Ensure data integrity of historical claims, enrollment, and risk data fed into models.
• Prepare executive presentations on bid strategy, financials, and risk.

Conocimientos

MA experience

Actuarial leadership

Regulatory knowledge

Cross-functional leadership

Educación

ASA or FSA

Herramientas

SQL

Python

R

SAS

Excel

Descripción del empleo

Job Description

A bit about this role:

The Pricing Actuary is a critical actuarial leader responsible for directing the strategy, modeling, and execution of our annual Medicare Advantage (MA) bidding process. This role demands deep, battle-tested expertise in Medicare Advantage bid preparation, rate cell modeling, CMS regulations, and risk adjustment mechanics.

Beyond pure technical depth, success in this role hinges on flawless operational execution: hit non-negotiable regulatory deadlines, bring process consistency to complex financial cycles, and work collaboratively across market leadership, clinical teams, finance, and executive stakeholders.

We place the highest value on proven real-world execution, technical precision, and collaborative leadership. While professional actuarial credentials are recognized, a track record of driving timely, accurate, and strategic MA bids is what truly defines success in this role.

Your Responsibilities and Impact will include:

• Medicare Advantage Bid Strategy & Execution
  • Annual Bid Leadership: Direct and oversee the end-to-end development, modeling, and submission of annual Medicare Advantage (Part C and Part D) bids, ensuring total compliance with CMS guidelines and strict adherence to statutory deadlines.
  • Product & Benefit Pricing Strategy: Partner with product, clinical, and local market leaders to design competitive benefit packages, evaluating product trade-offs, supplemental benefits, and cost-sharing mechanics against financial and growth targets.
  • Assumption Development: Establish, defend, and document core actuarial bid assumptions, including baseline utilization, unit cost trends, risk adjustment factors, administrative expense allocations, and margin targets.

• Modeling, Technical Rigor & Process Consistency
  • Actuarial Modeling & Automation: Build, refine, and maintain scalable bid pricing models, ensuring high standards of technical accuracy, model governance, and repeatable execution across expanding market footprints.
  • Sensitivity & Scenario Analysis: Perform complex scenario testing and sensitivity analyses to quantify the financial impacts of proposed CMS payment policy changes, risk model updates, benchmark shifts, and competitive market dynamics.
  • CMS Regulatory Translation: Interpret annual CMS Call Letters, Bid Instructions, and Rate Announcements, translating regulatory changes into actionable modeling adjustments and executive strategic guidance.

• Cross-Functional Collaboration & Strategic Alignment
  • Cross-Functional Partnership: Work seamlessly across Finance, Healthcare Economics, Clinical Operations, and Network Management to ensure bid assumptions reflect actual operational capabilities, clinical programs, and provider contracting terms.
  • Data Integration & Quality Assurance: Partner closely with data engineering and analytics teams to ensure the integrity, completeness, and accuracy of historical claims, enrollment, and risk adjustment data fed into bid models.
  • Executive & Regulatory Presentation: Prepare clear, compelling executive-level presentations summarizing bid strategy, financial returns, and risk profiles for executive leadership, board members, and regulatory reviewers.

Required skills and experience:

• • Core Actuarial & MA Experience: 8+ years of progressive healthcare actuarial experience, with at least 5+ years of deep, direct focus on Medicare Advantage bid pricing, plan design, and CMS bid submission.
  • Proven Track Record of Deadline Execution: Demonstrated ability to consistently drive complex, time-sensitive projects to completion on schedule, managing high-stakes regulatory deadlines with poise and precision.
  • Technical & Modeling Expertise: Advanced proficiency in actuarial modeling, claims data extraction, and financial modeling tools (e.g., SQL, Python, R, SAS, or advanced Excel modeling).
  • Deep Regulatory Mastery: Thorough understanding of Medicare Advantage pricing mechanics, including Part D direct subsidy/benefit design, CMS risk adjustment models (CMS-HCC, RxHCC), Star Ratings financial impacts, and benchmark calculations.
  • Collaborative Leadership: Exceptional interpersonal skills with a proven track record of working constructively across cross-functional teams, translating complex actuarial concepts into clear strategic choices for non-actuarial partners.

Desired skills and experience:

• (Actuarial designations are valued, but equivalent practical mastery and demonstrated track record are fully recognized).
  • Actuarial Credentials (Optional): Associate (ASA) or Fellow (FSA) of the Society of Actuaries, and Member of the American Academy of Actuaries (MAAA). Fully equivalent experience and bid leadership track record will be strongly considered.
  • Broad Financial & Managed Care Perspective: Experience interfacing with reserving, underwriting, risk adjustment operations, or medical economics functions.
  • Startup / High-Growth Agility: Comfort operating in a fast-paced, high-growth environment where processes are continuously refined and optimized.

#LI-DS1 #LI-Remote

Salary range:

$175,000 - $250,000 / year

The pay range listed for this position is the range the organization reasonably and in good faith expects to pay for this position at the time of the posting. Once the interview process begins, your talent partner will provide additional information on the compensation for the role, along with additional information on our total rewards package. The actual base salary offered will depend on a variety of factors, including the qualifications of the individual applicant for the position, years of relevant experience, specific and unique skills, level of education attained, certifications or other professional licenses held, and the location in which the applicant lives and/or from which they will be performing the job.

Our Total Rewards package includes:

• Employer sponsored health, dental and vision plan with low or no premium
• Generous paid time off
• $100 monthly mobile or internet stipend
• Stock options for all employees
• Bonus eligibility for all roles excluding Director and above; Commission eligibility for Sales roles
• Parental leave program
• 401K program
• And more....

*Our total rewards package is for full time employees only. Intern and Contract positions are not eligible.*

Founded in 2017, Devoted Health is on a mission to dramatically improve the health and well-being of older Americans by caring for everyone like they are family, and that includes our employees. Our robust and seamlessly integrated care platform merges advanced data and AI access with world-class clinical and service experiences to create a member experience that is unlike the industry norm. To continue building upon our mission, we want to bring together those who share our values, embrace change and advancement, and are enthusiastic about where we're going — all the while bringing their own unique qualities, experiences, and expertise, in hopes of further changing the healthcare experience.

Devoted is an equal opportunity employer. We are committed to a safe and supportive work environment in which all employees have the opportunity to participate and contribute to the success of the business. We value diversity and collaboration. Individuals are respected for their skills, experience, and unique perspectives. This commitment is embodied in Devoted’s Code of Conduct, our company values and the way we do business.

As an Equal Opportunity Employer, the Company does not discriminate on the basis of race, color, religion, sex, pregnancy status, marital status, national origin, disability, age, sexual orientation, veteran status, genetic information, gender identity, gender expression, or any other factor prohibited by law. Our management team is dedicated to this policy with respect to recruitment, hiring, placement, promotion, transfer, training, compensation, benefits, employee activities and general treatment during employment.