Senior Director, Actuarial - Risk Adjustment

Acturhire; New York (NY); Remote; USD 219,000 - 287,000; Full time

Benefits offered by this job

Employee benefits

Unlimited vacation

Equity grants

Annual performance bonuses

Job summary

Oscar Health is seeking a Senior Director, Actuarial – Risk Adjustment to lead ACA risk adjustment analytics, financial reporting, forecasting, and strategic analysis. You will manage a team and partner with Finance, Market P&L, Risk Adjustment Operations, Medical Economics, and Data Science to inform senior leadership.

You will report to the Vice President, Corporate Actuarial. This fully remote role is open to US residents (excluding certain states).

Qualifications

• Bachelor's degree in a STEM field or 4 years of commensurate experience.
• 12+ years of quantitative analysis in the healthcare industry.
• 5+ years of collaborating with an Executive Leadership Committee.
• Proven experience in a pricing role or analytics-driven leadership.
• Strong government programs risk adjustment expertise, preferably ACA Marketplace.

Responsibilities

• ACA Risk Adjustment Financial Reporting & Forecasting: Lead financial reporting and forecasting for ACA risk adjustment, including monthly close, audits, regulatory reviews.
• Oscar Risk Score Analysis & Projection: Develop insights and projections for Oscar's risk scores and risk adjustment performance.
• Market Morbidity Analysis & Projection: Analyze morbidity drivers and financial implications with external stakeholders.
• Executive Advising & Reporting: Lead executive-facing reporting and strategic recommendations.
• Cross-Functional Leadership: Build partnerships across Finance, Risk Adjustment Operations, Market P&L.
• Advanced Analytics & Growth: Direct analytics to inform pricing and enterprise growth.
• Team Management & Development: Lead and mentor actuarial professionals.
• Other duties as assigned.

Skills

Executive leadership

Pricing

Actuarial analytics

Healthcare analytics

Education

Bachelor's degree in STEM or related

Job description

Hi, we're Oscar. We're hiring a Senior Director, Actuarial - Risk Adjustment to join our Actuarial team.

Oscar is the first health insurance company built around a full stack technology platform and a relentless focus on serving our members. We started Oscar in 2012 to create the kind of health insurance company we would want for ourselves—one that behaves like a doctor in the family.

About the role:

The Senior Director, Actuarial – Risk Adjustment leads Oscar's ACA risk adjustment actuarial function, with responsibility for financial reporting, forecasting, and strategic analysis. You manage a team and partners across Finance, Market P&L, Risk Adjustment Operations, Medical Economics, and Data Science to inform business strategy and financial disclosures. You will translate risk adjustment performance, market dynamics, and financial implications into clear, actionable insights for senior leadership.

You will report to the Vice President, Corporate Actuarial.

Work Location:

This position is fully remote and open to candidates residing in the U.S., excluding Alaska; Delaware; Hawaii; Louisiana; Montana; North Dakota; Oklahoma; West Virginia; Wyoming; and U.S. Territories. Daily work is completed from your home office, with occasional travel required for team meetings and company events. #LI-Remote

Pay Transparency:

The base pay for this role in the states of California, Connecticut, New Jersey, New York, and Washington is: $218,592 - $286,902 per year. The base pay for this role in all other locations is: $196,733 - $258,212 per year.. You are also eligible for employee benefits, participation in Oscar's unlimited vacation program, company equity grants and annual performance bonuses.

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.

Requirements:

• 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.

Bonus points:

• 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.

This is an authentic Oscar Health job opportunity.

At Oscar, being an Equal Opportunity Employer means more than upholding discrimination-free hiring practices. It means that we cultivate an environment where people can be their most authentic selves and find both belonging and support. We're on a mission to change health care -- an experience made whole by our unique backgrounds and perspectives.

Pay Transparency:

Final offer amounts, within the base pay set forth above, are determined by factors including your relevant skills, education, and experience. Full-time employees are eligible for benefits including: medical, dental, and vision benefits, 11 paid holidays, paid sick time, paid parental leave, 401(k) plan participation, life and disability insurance, and paid wellness time and reimbursements.

Artificial Intelligence (AI):

Our AI Guidelines outline the acceptable use of artificial intelligence for candidates and detail how we use AI to support our recruiting efforts.

Reasonable Accommodation:

Oscar applicants are considered solely based on their qualifications, without regard to applicant’s disability or need for accommodation. Any Oscar applicant who requires reasonable accommodations during the application process should contact the Oscar Benefits Team ([e-mail]) to make the need for an accommodation known.

California Residents:

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