Remote Actuarial Senior Director – Risk Adjustment

Oscar Health; United States; Remote; USD 197,000 - 287,000; Full time

Job summary

Oscar Health is seeking a Senior Director, Actuarial – Risk Adjustment to lead ACA risk adjustment reporting, forecasting, and analytics from a fully remote US-based role. You will manage a team, partner with Finance, Market P&L, Risk Adjustment Operations, Medical Economics, and Data Science to translate performance into strategic insights.

You will report to the Vice President, Corporate Actuarial. This role requires extensive actuarial leadership, strong communication, and a depth of ACA risk

Qualifications

• Bachelor's degree in a STEM field, or 4 years commensurate experience.
• 12+ years of quantitative analysis in the healthcare industry.
• 5+ years of collaborating and influencing an Executive Leadership Committee.
• Proven experience in a pricing role, or a related analytics-driven leadership role.
• Strong government programs risk adjustment subject matter expertise, preferably in ACA Marketplace.
• Extensive experience leading actuarial financial reporting, including claims reserving and risk adjustment.
• Qualified (or willing to become qualified) to serve as appointed actuary for insurance companies the American Academy of Actuaries’ Specific qualification standard.
• Excellent communication, collaboration, and relationship-building skills.
• Strong process management skills, with experience streamlining workflows and driving operational efficiency.
• Collaborative and influential leadership style, with experience partnering across multiple teams and stakeholders.
• Strong familiarity with ACA-specific healthcare laws, regulations, and compliance requirements.
• Fellow of the Society of Actuaries (SOA), or on the track to become one.

Responsibilities

• ACA Risk Adjustment Financial Reporting & Forecasting: Lead financial reporting and forecasting for ACA risk adjustment, including monthly close, external audits, regulatory reviews, and other finance-related activities.
• Oscar Risk Score Analysis & Projection: Develop strategic insights and projections regarding Oscar's ultimate risk scores and risk adjustment performance.
• Market Morbidity Analysis & Projection: Analyze market morbidity drivers and their financial implications, coordinating with key external stakeholders including industry consultants.
• Executive Advising & Reporting: Lead executive-facing reporting by managing key financial forecasts and delivering presentations that translate complex actuarial insights into actionable strategic recommendations for senior leadership.
• Cross-Functional Leadership: Build strategic partnerships across key business units (e.g., Finance, Risk Adjustment Operations, Market P&L) and represent the Actuarial function in executive forums.
• Advanced Analytics & Growth: Direct advanced analytics initiatives, leveraging key findings to shape enterprise-wide decision-making regarding pricing, strategic business growth, and network strategies.
• Team Management & Development: Lead and develop a team of actuarial professionals, providing coaching, mentorship and professional development to foster continuous growth across the Actuarial team
• Other duties as assigned.

Skills

Executive leadership

Financial forecasting

Actuarial leadership

Cross-functional collaboration

Advanced analytics

Communication

Education

Bachelor's degree in STEM

Job description

Oscar Health is seeking a Senior Director, Actuarial – Risk Adjustment to lead ACA risk adjustment reporting, forecasting, and analytics from a fully remote US-based role. You will manage a team, partner with Finance, Market P&L, Risk Adjustment Operations, Medical Economics, and Data Science to translate performance into strategic insights.

You will report to the Vice President, Corporate Actuarial. This role requires extensive actuarial leadership, strong communication, and a depth of ACA risk