Director, Actuarial Services

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The Director of Actuarial Services will be a leader who helps guide the development and execution of the entire actuarial function, assist in strategic initiatives, and will be an integral part of the Peak Health management team.
Core accountabilities include pricing/underwriting, financial reserving, forecasting, trend analysis, value-based contract performance evaluation, and supporting business decisions through a medical economic framework.
The Director of Actuarial Services will serve as a key advisor to the executive leadership team and work collaboratively with various functions within the organization such as finance, accounting, analytics, product, population health, clinical teams, provider contracting, and client relationship managers.
To be successful in this role, the Director of Actuarial Services will need contemporary in-depth knowledge of the insurance industry; excellent analytical, decision-making, and problem-solving skills; strong time management and prioritization capabilities; and ability to collaborate with others at all levels.

MINIMUM QUALIFICATIONS:

EDUCATION, CERTIFICATION, AND/OR LICENSURE:

1. Bachelor's degree in actuarial science, mathematics, data science, finance, statistics, economics, or related field.

2. ASA designation from the Society of Actuaries.

EXPERIENCE:

1. Eight (8) years of progressive healthcare actuary leadership experience, including direct prior experience with healthcare claims data, partner/provider analytics, payer-provider contracting, and/or value-based care.

2. Two (2) years of experience managing a team.

PREFERRED QUALIFICATIONS:

EDUCATION, CERTIFICATION, AND/OR LICENSURE:

1. FSA designation from the Society of Actuaries.

EXPERIENCE:

1. Medicare Advantage bid pricing experience.

2. Membership in the American Academy of Actuaries.

CORE DUTIES AND RESPONSIBILITIES: The statements described here are intended to describe the general nature of work being performed by people assigned to this position.  They are not intended to be constructed as an all-inclusive list of all responsibilities and duties.  Other duties may be assigned.

1. Consistently work with senior leadership by providing balanced actuarial insights and support strategic decision-making.

2. Act as a subject matter expert on actuarial matters in cross-functional meetings.

3. Manage teams both internally and externally to support business objectives.

4. Lead and oversee governmental product rate setting processes to ensure accuracy, compliance, and alignment with organizational strategy.

5. Maintain financial models where appropriate to support decision making.

6. Provide accurate and timely financial information for organizational planning.

7. Assess and manage financial risks related to insurance products, payment models and other financial instruments.

8. Develop effective strategies to be aware of regulatory changes.

9. Train and develop colleagues as needed.

10. Manage and coordinate commercial rate filings, including preparation, review, and submission.

11. Direct repricing initiatives for self-funded clients to maintain competitiveness and financial sustainability.

12. Guide and support underwriting activities for fully insured clients, ensuring sound risk assessment and pricing strategies.

13. Develop and monitor reinsurance arrangements to optimize financial protection and risk management.

14. Oversee monthly financial accruals for incurred but not reported (IBNR) claims, ensuring timely and accurate reporting.

15. Analyze and report on product gross margin performance to drive strategic decision-making.

16. Design, implement, and evaluate value-based product models, including ongoing performance monitoring.

17. Negotiate and manage contracts to support organizational goals and maintain strong business partnerships.

PHYSICAL REQUIREMENTS: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

WORKING ENVIRONMENT: The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

1. Standard Office Environment.

SKILLS AND ABILITIES:

1. Ability to work independently to solve complex challenges.

2. Proficient in data manipulation, analytics, modeling, and visualization tools (e.g., Advanced XLS, SQL, SAS, PowerBI, Tableau, R, Python).

3. Strong interpersonal skills (written and verbal) and the ability to convey complex topics in understandable mediums to a variety of audiences.

4. Willingness and comfort to work on a variety of projects, potentially not directly aligned with actuarial science.   

5. Creative problem-solving skills and willingness to engage at all levels of the process.

Additional Job Description:

Scheduled Weekly Hours:

40

Shift:

Exempt/Non-Exempt:

United States of America (Exempt)

Company:

PHH Peak Health Holdings

Cost Center:

2501 PHH Risk Admin