VP, Medicare Advantage Chief Actuary

Lumeris; United States; À distance; USD 250 000 - 500 000; Plein temps

Résumé du poste

Lumeris in the United States is seeking a VP, Medicare Advantage Chief Actuary to lead actuarial functions for the Medicare Advantage line, setting rates, pricing, and risk-adjusted strategies that drive financial sustainability and competitive Star Ratings.

You will build and mentor a cross-functional team, oversee budget and resource planning, and partner with Risk Adjustment, Pharmacy, Health Plan Product, and Stars Strategy to provide strategic direction to executives.

Responsabilités

• Strategic Leadership & Talent Development: Guides strategic direction and develops cross-functional MA pricing and analytics teams.
• Executive Business Intelligence & Plan Performance: Aligns BI and financial reporting for executive leadership and board.
• MA Product Design & Pricing Architecture: Serves as actuarial authority for Medicare Advantage pricing and design.

Description du poste

Your Future is our Future

At Lumeris, we believe that our greatest achievements are made possible by the talent and commitment of our team members. That's why we are actively seeking talented and collaborative individuals who are passionate about making a difference in the healthcare industry. Join us today as we strive to create a system of care that every doctor wants for their own family and become part of a community that values its people and empowers you to make an impact.

We're excited to consider every qualified candidate authorized to work in the United States, although we are unable to sponsor visas for this role at this time.

VP, Medicare Advantage Chief Actuary

Position Summary

Provides oversight, strategic direction, process improvements, and best practices for the department. Responsible for all actuarial and underwriting/pricing functions in support of Essence Healthcare’s Medicare Advantage plan operations. Partnering closely with the leaders of Risk Adjustment, Pharmacy, Health Plan Product, and Stars Strategy, this role delivers forward-thinking strategies and provides business direction regarding actuarial rate setting, pricing, annual CMS Part C and Part D bid submissions, risk adjustment factor forecasting, premium development, valuation and statutory reserve setting (including IBNR), financial risk management, product development, and performance analytics to maintain long-term financial sustainability, market competitiveness, and high Star Ratings performance.

Job Description

Primary Responsibilities:

• Strategic Leadership & Talent Development: Develops, implements, and guides strategic direction for the Medicare Advantage actuarial function. Oversees, coaches, mentors, motivates, supports, and develops a cross‑functional team, building specialized internal capabilities in Medicare Advantage pricing, Part D benefit economics, reserving, risk adjustment, healthcare economics, and advanced healthcare analytics. Oversees goal setting/review, regular guidance and 1-1 check-ins, career development/planning, upskilling, resource allocation, staffing, budget creation/management, succession planning, and other People & Culture programs/activities as needed. Fosters accountability, collaboration, and innovation to ensure organizational goals are met.

• Executive Business Intelligence & Plan Performance: Oversees and supports cross‑functional alignment to ensure the best possible business intelligence and understanding of company financials in communications to executive team and the Essence Healthcare Board of Directors; delivers clear visibility into emerging Medical Loss Ratios (MLR), emerging claims trends, membership and revenue dynamics, member cohort profitability, risk score performance, and regulatory revenue shifts.

• MA Product Design & Pricing Architecture: Serves as the primary actuarial authority for Medicare Advantage