JOB SUMMARY

The Medicare Lead Actuary will lead the development and submission of Medicare Advantage bids while ensuring compliance with CMS requirements and driving strategic growth initiatives. This role combines technical actuarial expertise with leadership and strategic business partnership. In addition to bid submissions the Medicare Lead Actuary will support research and modeling for product expansion feasibility studies, research medical cost improvement opportunities, and support other ongoing and ad-hoc actuarial or analytics research.

JOB SPECIFICATIONS

• Lead end-to-end bid development process for Medicare Advantage products.
• Develop and maintain bid pricing models, including trend analysis, risk score projections, and benefit design optimization.
• Partner with Product, Sales, and Finance teams to align bid strategy with organizational goals.
• Ensure compliance with CMS requirements and actuarial standards of practice.
• Present bid recommendations to senior leadership and support strategic decision-making.
• Conduct competitive analysis and market research to inform bid positioning.
• Oversee documentation of bid assumptions, methodologies, and decisions.
• Monitor bid performance and develop action plans for variances.
• Improve efficiency of bid development process.
• Improve strategic decision-making with data-driven insights.

QUALIFICATIONS:

• Education/Specialized Training/Licensure: Bachelor's degree in mathematics, Actuarial Science, or related field required.
• Associate of the Society of Actuaries (ASA).
• Work Experience (Years and Area): 2+ years of Medicare Advantage pricing and bid development experience.
• 5+ years of Actuarial experience required.

Management Experience (Years and Area): N/A 2+ years of management experience.

Software Proficiencies: Excel, SQL Excel, MS SQL Server

Other:

• Knowledge of risk adjustment methodologies
• Experience with actuarial modeling tools and bid pricing
• Strong analytical and problem-solving abilities.
• Excellence in project management and meeting deadlines.
• Outstanding communication skills with technical and non-technical audiences.
• Ability to influence and collaborate across departments.
• Strategic thinking and business acumen.
• Knowledge of risk adjustment methodologies
• Experience with actuarial modeling tools and bid pricing
• Strong analytical and problem-solving abilities.
• Excellence in project management and meeting deadlines.
• Outstanding communication skills with technical and non-technical audiences.
• Ability to influence and collaborate across departments.
• Strategic thinking and business acumen.

Reports to Position Title: Actuarial Director

COMPETENCIES

• Analytical Thinking
• Motivated
• Results Oriented
• Taking Initiative