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Pricing Actuary – Medicare Advantage
Devoted HealthCore Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates extensive expertise in Medicare Advantage bid pricing, actuarial modeling, and compliance with CMS guidelines. Proven ability to lead cross-functional teams and deliver complex projects on time while maintaining data quality and financial integrity.
Highest-signal resume keywords
Medicare Advantage Bid PricingActuarial ModelingCMS ComplianceFinancial Modeling ToolsCross-Functional Collaboration
Tech Stack
Tools & technologiesAbout the role
Key responsibilities & impact- Direct and oversee the end-to-end development, modeling, and submission of annual Medicare Advantage Part C and Part D bids
- Ensure compliance with CMS guidelines and adherence to statutory deadlines
- Partner with product, clinical, and local market leaders to design competitive benefit packages
- Establish, defend, and document actuarial bid assumptions
- Build, refine, and maintain scalable bid pricing models
- Perform scenario testing and sensitivity analyses for CMS payment policy changes, risk model updates, benchmark shifts, and competitive dynamics
- Interpret CMS Call Letters, Bid Instructions, and Rate Announcements and translate changes into modeling adjustments and executive guidance
- Collaborate with Finance, Healthcare Economics, Clinical Operations, and Network Management
- Partner with data engineering and analytics teams to ensure claims, enrollment, and risk adjustment data quality
- Prepare executive-level presentations on bid strategy, financial returns, and risk profiles for leadership, board members, and regulatory reviewers
Requirements
What you’ll need- 8+ years of progressive healthcare actuarial experience
- At least 5+ years of deep, direct focus on Medicare Advantage bid pricing, plan design, and CMS bid submission
- Demonstrated ability to consistently drive complex, time-sensitive projects to completion on schedule
- Advanced proficiency in actuarial modeling, claims data extraction, and financial modeling tools such as SQL, Python, R, SAS, or advanced Excel modeling
- Thorough understanding of Medicare Advantage pricing mechanics, including Part D direct subsidy/benefit design, CMS risk adjustment models (CMS-HCC, RxHCC), Star Ratings financial impacts, and benchmark calculations
- Exceptional interpersonal skills and proven cross-functional collaboration experience
- Actuarial designations ASA, FSA, or MAAA are optional; equivalent practical mastery and bid leadership track record are recognized
- Experience interfacing with reserving, underwriting, risk adjustment operations, or medical economics functions
- Comfort operating in a fast-paced, high-growth environment
Benefits
Comp & perks- Employer sponsored health, dental and vision plan with low or no premium
- Generous paid time off
- $100 monthly mobile or internet stipend
- Stock options for all employees
- Bonus eligibility for all roles excluding Director and above
- Parental leave program
- 401K program
ATS Keywords
✓ Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Actuarial ModelingClaims Data ExtractionFinancial ModelingSQLPythonRSASAdvanced Excel ModelingMedicare Advantage Pricing MechanicsBenchmark Calculations
Soft Skills
Exceptional Interpersonal SkillsProven Cross-Functional Collaboration
Certifications & Qualifications
ASAFSAMAAA
Industry Keywords
Medicare AdvantageCMS GuidelinesRisk Adjustment ModelsStar RatingsBenefit Design