VP, Medicare Advantage – Chief Actuary

Lumeris

. Develop, implement, and guide strategic direction for the Medicare Advantage actuarial function .

Posted 11/6/2026full-timeRemote • United StatesLead💰 $175,300 - $249,100 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates extensive expertise in Medicare Advantage actuarial functions, including bid preparation, pricing development, and regulatory compliance. Proven leadership in managing cross-functional teams and developing innovative actuarial methodologies aligned with healthcare economics.

Highest-signal resume keywords

Medicare Advantage Bid PreparationActuarial Pricing DevelopmentCMS Risk Adjustment ModelsExecutive Leadership in HealthcareFellow of the Society of Actuaries (FSA)

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Actuarial ScienceHealthcare EconomicsStatistical AnalysisFinancial ModelingRisk ManagementCost Trend AnalysisRegulatory ComplianceData InterpretationPricing Strategy DevelopmentStatutory IBNR Reserving

Soft Skills

Team LeadershipCoaching and MentoringCommunication SkillsNegotiation SkillsOrganizational Skills

Tools & Technologies

HPMSExecutive DashboardsActuarial SoftwareData Analytics ToolsFinancial Reporting Systems

Certifications & Qualifications

Fellow of the Society of Actuaries (FSA)Member of the American Academy of Actuaries (MAAA)CMS Medicare Advantage Part C and Part D Actuarial Certifications

Industry Keywords

Medicare AdvantageManaged CareHealth ActuarialValue-Based CareStar Ratings

About the role

Key responsibilities & impact

Develop, implement, and guide strategic direction for the Medicare Advantage actuarial function
Oversee, coach, mentor, motivate, support, and develop a cross-functional actuarial and healthcare economics team
Manage goal setting, career development, upskilling, resource allocation, staffing, budgeting, and succession planning
Provide executive business intelligence on MLR, claims trends, membership and revenue dynamics, profitability, risk scores, and regulatory revenue shifts
Serve as primary actuarial authority for Medicare Advantage product strategy and pricing
Evaluate plan benefit packages, supplemental benefits, formularies, cost-sharing structures, service-area expansion, and specialized plan offerings
Oversee actuarial valuation, pricing, unpaid claim liabilities, IBNR, premium deficiency reserves, and risk-sharing settlements
Lead end-to-end annual Medicare Advantage Part C and Part D bid development, modeling, certification, and HPMS submission
Govern assumptions, scenario testing, quality controls, executive review, and bid-to-actual monitoring
Interpret CMS policy and model financial impacts of rate announcements, benchmark adjustments, and risk adjustment changes
Ensure actuarial financial statement items comply with CMS, actuarial, regulatory, and accounting guidance
Maintain governance, quality assurance, compliance, and audit readiness for CMS exams, RADV audits, and encounter data reviews
Develop innovative actuarial methodologies and incorporate Star Ratings economics into strategic plans and bid curves
Build cross-functional partnerships and align actuarial strategy with value-based care opportunities
Lead the company actuarial program and support credentialing of junior and mid-level actuarial staff
Produce pricing analyses, reports, executive dashboards, bid-to-actual variance analyses, cost trends, and risk score tracking

Requirements

What you’ll need

Bachelor’s degree in Actuarial Science, Mathematics, Statistics, Economics, or related quantitative field
Fellow of the Society of Actuaries (FSA) and Member of the American Academy of Actuaries (MAAA) in good standing
Meet qualification standards to issue Statements of Actuarial Opinion and CMS Medicare Advantage Part C and Part D Actuarial Certifications
15+ years of health actuarial experience
At least 7–10 years of direct, senior leadership experience in Medicare Advantage bid preparation, Part C/Part D pricing development, reserving, risk adjustment, and CMS health plan financial management
Significant executive leadership within a Medicare Advantage organization, HMO, or national managed care carrier
Direct exposure to executive leadership and governing boards
Expert understanding of CMS bid mechanics, HPMS filings, CMS-HCC and RxHCC risk adjustment models, Part D direct subsidy/formulary economics, Star Ratings financial mechanics, and statutory IBNR reserving
Excellent financial knowledge and understanding of healthcare economics, actuarial and accounting practices, value-based care delivery, capitation, two-sided risk sharing, and Medicare Advantage statutory balance sheet management
Proven ability to develop, coach, mentor, and empower cross-functional teams
Experience developing pricing strategies and plans for new products and innovative services, including specialized MA plans and supplemental benefit packages
Ability to collaborate across teams and organizational levels under strict statutory timelines
Experience partnering with sales and growth teams on AEP targets, geographic service area expansions, and competitive positioning
Strong communication and negotiation skills, including presenting complex actuarial models and financial trade-offs to executives, plan leaders, and board committees
Ability to organize and prioritize workflow during high-pressure bid cycles and regulatory filing windows
Ability to work with integrity and uphold organizational values
Excellent written and verbal communication skills
Authorized to work in the United States; visa sponsorship unavailable

Benefits

Comp & perks

Medical, Vision and Dental Plans
Tax-Advantage Savings Accounts (FSA & HSA)
Life Insurance and Disability Insurance
Paid Time Off (PTO, Sick Time, Paid Leave, Volunteer & Wellness Days)
Employee Assistance Program
401k with company match
Employee Resource Groups
Employee Discount Program
Learning and Development Opportunities
Performance-based incentive and/or equity may be available depending on the position
Approved COVID-19 vaccination coverage/requirement for applicable member-facing roles