Senior Staff Actuary - Medicare

EmblemHealth; New York (NY); On-site; USD 93,000 - 178,000; Full time

Job summary

EmblemHealth is seeking a senior actuary to lead pricing and reserve strategy development and coordinate actuarial resources across affiliates. You will collaborate with Product Management and Finance to analyze performance, refine rate structures, and oversee regulatory filings.

Strong leadership and communication are essential. The role requires extensive actuarial experience, ASA designation, and preferred FSA/MAAA credentials, with oversight of multiple lines of business and mentorship

Qualifications

• Bachelor’s degree in Actuarial Science, Mathematics, or related finance/business required.
• ASA certification required.
• FSA/MAAA preferred for advancement.
• Strong mathematical and analytical skills essential.

Responsibilities

• Lead pricing and reserve-strategy analyses and coordinate actuarial resources.
• Analyze financial performance of blocks of business with cross-functional teams.
• Oversee filings of premium rates and costs with regulators (e.g., CMS, NY DoH).
• Collaborate with Risk Adjustment and other departments.
• Mentor and manage staff across lines of business (e.g., ACA, Large Group, Medicare).
• Perform other duties as assigned.

Skills

Actuarial Experience

ASA Certification

FSA Preferred

Management Experience

Analytical Skills

MS Office Proficiency

Reporting to Senior Management

Communication Skills

Reimbursement Knowledge

Mathematics Knowledge

Education

Bachelor’s degree in Actuarial Science, Mathematics, other physical science, or related finance/business degree

ASA required

MAAA preferred

FSA preferred

Tools

MS Office Suite

Job description

Summary Of Position

• Provide the analytical resources necessary for the development of overall pricing and reserve setting strategies.
• Lead projects to analyze current rate structures and develop improvements and alternatives.
• Coordinate the actuarial staff as needed to support the activities of the affiliates.
• Lead actuarial staff as needed to support the activities of the affiliates.

Principal Accountabilities

• Work closely with Senior Product Management and Finance to analyze financial performance of blocks of business, including membership, trend, and financial analyses.
• Work collaboratively with all areas of the organization to identify opportunities to improve product performance.
• Oversee the development and filing of premium rates and/or expected costs with the appropriate regulatory authority (e.g., CMS, New York Department of Health).
• Work closely with Risk Adjustment and other areas.
• Advise and develop direct reports accountable for at least one line of business (e.g. ACA, Large Group, Medicare, Medicaid, SSP), as well as other staff.
• Perform other duties as assigned or required.

Qualifications

Education, Training, Licenses, Certifications

• Bachelor’s degree in Actuarial Science, Mathematics, other physical science, or related finance/business degree required
• Associate of the Society of Actuaries (A.S.A.) required
• Member of the American Academy of Actuaries (M.A.A.A.) preferred
• Fellow of the Society of Actuaries (F.S.A.) preferred

Relevant Work Experience, Knowledge, Skills, And Abilities

• 10+ years of relevant, professional work experience and/or education required
• 6+ years of actuarial experience with ASA; or 5+ years’ experience with an FSA required5+ years health insurance actuarial experience, preferably in the managed care industry required
• 1+ year of management experience required
• Comprehensive understanding of actuarial principles and methodologies; strong mathematical and analytical skills required
• Knowledge of reimbursement methodologies required
• Ability to develop actionable reports for senior management required
• Excellent written and oral communication skills to deliver complex information required
• Proficiency with MS Office (Word, Excel, Access, PowerPoint, Outlook); data extraction, simulations, automation required

Additional Information

• Requisition ID: 1000003335
• Hiring Range: $92,880-$178,200