Actuary, Risk and Compliance

Accountabilities

- Identify, assess, and communicate actuarial and business risks, including potential financial impacts and appropriate mitigation strategies.

- Support Medicare Advantage and Prescription Drug Plan bid filings by interpreting and implementing applicable CMS guidance, review standards, and compliance controls.

- Maintain the internal version of the CMS Out-of-Pocket Cost (OOPC) Model, coordinate required inputs from business partners, and run and interpret model results.

- Partner with pricing actuaries to investigate and resolve OOPC and Total Beneficiary Cost test failures and other compliance issues.

- Develop and maintain processes and controls designed to reduce compliance risk and improve the accuracy and consistency of bid submissions.

- Participate in CMS audits, regulatory reviews, and other assessments related to Medicare bids.

- Identify opportunities to improve bid-filing processes, tools, and controls while supporting continuous operational improvement.

- Provide actuarial peer review, technical counsel, and guidance on company, industry, regulatory, and actuarial practices.

- Monitor developments in actuarial methodologies, insurance operations, laws, and regulations and assess their potential business implications.

- Advise senior leaders on significant actuarial, regulatory, and risk-related matters and contribute to functional strategies.

- Lead projects involving actuarial and non-actuarial stakeholders, with the potential to manage and develop a direct report.

Requirements

- Bachelor’s degree required.

- 8+ years of relevant technical experience.

- At least 2 years of project leadership experience, including the ability to coordinate complex initiatives across multiple stakeholders.

- Associate of the Society of Actuaries (ASA) or Fellow of the Society of Actuaries (FSA) designation required.

- Member of the American Academy of Actuaries (MAAA) required.

- Strong understanding of actuarial risk assessment, regulatory requirements, insurance operations, and financial risk analysis.

- Demonstrated ability to analyze complex problems, evaluate potential financial consequences, and develop practical risk mitigation strategies.

- Excellent written and verbal communication skills, with the ability to clearly articulate technical concepts and recommendations to diverse audiences.

- Medicare Advantage experience is preferred, particularly experience related to pricing, product development, bid submissions, or CMS requirements.

- Experience managing large projects involving both actuarial and non-actuarial teams is preferred.

- Strong collaboration, analytical thinking, project management, and stakeholder management capabilities.

Benefits

- Base salary range of $129,300–$177,800 per year , with actual compensation varying based on location, experience, skills, education, certifications, and other job-related factors.

- Eligibility for a bonus incentive plan based on company and/or individual performance.

- Fully remote work arrangement within the United States.

- Medical, dental, and vision benefits.

- 401(k) retirement savings plan.

- Paid time off, company and personal holidays.

- Paid parental and caregiver leave.

- Short-term and long-term disability coverage.

- Life insurance and additional employee well-being programs.

- 40-hour standard workweek.

- Occasional travel to company offices may be required for training or meetings.

- Opportunity to contribute to high-impact actuarial, compliance, pricing, and risk-management initiatives in a complex healthcare environment.

How Jobgether works:
We use an AI-powered matching process to ensure your application is reviewed quickly, objectively, and fairly against the role's core requirements. Our system identifies the top-fitting candidates, and this shortlist is then shared directly with the hiring company. The final decision and next steps (interviews, assessments) are managed by their internal team.
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