The Vice President, Chief Actuary is a senior executive leader responsible for all actuarial functions, including pricing, reserving, underwriting, forecasting, and insurance risk management. This role plays a critical part in ensuring the financial integrity of the health plan while providing strategic insights to executive leadership.
The Chief Actuary oversees actuarial and underwriting operations across government and commercial lines of business, serves as the Appointed Actuary, and ensures full regulatory compliance, actuarial governance, and the development of actuarial talent.
Work Arrangement
* Remote: Open to applicants across the United States (excluding CA, IL, ND, NY, OH, WA, and WY)
* Hybrid: Candidates located within 60 miles of Albuquerque are expected to work on-site Tuesday through Thursday
Key Responsibilities
Product & Pricing Strategy
* Lead Medicaid rate adequacy assessments and maintain strong partnership with state agencies
* Oversee capitation rate assumptions and ensure actuarial soundness
* Support negotiations and submissions to state regulators and CMS
* Analyze risk adjustment, population acuity, eligibility changes, and payment models
* Ensure commercial and Medicare pricing is both competitive and compliant
* Set premium rates across individual, group, ACA marketplace, and Medicare Advantage plans
* Oversee trend analysis, including medical cost inflation and utilization shifts
* Approve rate filings submitted to regulatory bodies
* Drive product development, underwriting, and pricing initiatives
* Partner with product, finance, and underwriting teams to support innovation and growth
* Lead and develop underwriting teams
* Maintain pricing models to reflect regulatory and benefit changes
Financial Oversight & Forecasting
* Oversee key actuarial balance sheet items, including:
* Claims reserves (IBNR)
* Risk adjustment revenue and settlements
* Premium deficiency reserves
* Risk corridor positions
* Partner with finance on forecasting and long-term planning
* Lead actuarial analytics functions
* Provide insights into claims trends, provider performance, pharmacy costs, and population health
Regulatory & Statutory Accountability
* Serve as the Appointed Actuary and sign statutory opinions
* Interface with regulatory bodies, including:
* State Departments of Insurance
* Medicaid agencies
* Centers for Medicare & Medicaid Services (CMS)
Ensure compliance with:
* Medicaid rate certification requirements
* Medical Loss Ratio (MLR) thresholds
* Mental health parity regulations
* Risk adjustment submission and validation (commercial lines)
Governance & Leadership
* Ensure compliance with Actuarial Standards of Practice
* Recruit, mentor, and develop actuarial leadership talent
* Maintain relationships with external auditors and consulting partners
* Foster a culture of collaboration, innovation, and accountability
Qualifications
* Bachelor’s degree in Actuarial Science, Mathematics, or related field
* FSA or ASA designation required; MAAA required
* 10+ years of actuarial experience in health insurance, including leadership roles
* Deep expertise in Medicaid; working knowledge of Medicare Advantage, ACA, and/or commercial markets
* Strong background in pricing, reserving, forecasting, and regulatory filings
* Excellent executive communication and stakeholder management skills
Preferred Experience
* Value-based care, risk adjustment, and population health analytics
* Enterprise risk management or capital strategy
* Ability to translate complex analytics into clear business insights
* Strategic mindset with a collaborative, results-driven approach
Benefits
* Competitive compensation package
* Medical, dental, and vision insurance (effective day one for eligible employees)
* Flexible Spending Accounts (FSAs)
* Generous PTO and wellness programs
* Retirement plans with employer match
* Continuing education and career development support
* Life insurance and disability coverage
