Director, Actuarial – Risk Management Services

Sharp HealthCare

. Provide strategic leadership for actuarial analysis, risk adjustment, underwriting, and financial forecasting activities.

Posted 11/5/2026full-timeCalifornia • United StatesLead💰 $76 - $120 per hourWebsite

Core Competencies

Role fit

Core Competencies

Use this summary to align your resume positioning with the role.

Demonstrates advanced expertise in actuarial analysis, risk adjustment, and healthcare finance, with a strong focus on pricing strategies and regulatory compliance. Proven leadership in managing actuarial teams and collaborating across functions to drive strategic business decisions.

Highest-signal resume keywords

Actuarial AnalysisRisk AdjustmentHealthcare FinanceLeadership ExperienceFinancial Forecasting

ATS Keywords

Tailor your resume

Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills

PricingUnderwritingFinancial AnalyticsActuarial MethodologiesForecastingRisk AssessmentHealthcare ReimbursementRegulatory FilingsActuarial ModelsData Analysis

Soft Skills

Organizational SkillsProject ManagementProblem-SolvingDecision-Making

Tools & Technologies

Microsoft ExcelFinancial Analytics Tools

Certifications & Qualifications

Associate of the Society of Actuaries (ASA)Member of the American Academy of Actuaries (MAAA)Fellow of Society of Actuaries (FSA)

Industry Keywords

Health InsuranceManaged CareHealthcare ConsultingValue-Based ReimbursementCapitationDelegated-Risk ArrangementsRegulatory ComplianceActuarial Standards of PracticeMedical Loss Ratio ReportingACA Risk Adjustment

About the role

Key responsibilities & impact

Provide strategic leadership for actuarial analysis, risk adjustment, underwriting, and financial forecasting activities.
Translate complex data into actionable business insights informing pricing, revenue optimization, product strategy, and enterprise decision-making.
Collaborate with Finance, Clinical, Operations, and Executive Leadership on risk assessment, sustainable growth, and healthcare cost management.
Serve as a strategic advisor to executive leadership on actuarial, underwriting, risk adjustment, and healthcare finance matters.
Lead actuarial, underwriting, and commercial pricing activities across applicable lines of business.
Manage premium budgeting, rate development, underwriting standards, and pricing recommendations.
Evaluate claims experience, utilization trends, benefit design, demographics, provider economics, and pricing factors.
Maintain actuarial models, pricing tools, assumptions, and methodologies.
Establish and oversee risk adjustment strategy, governance, forecasting, reconciliation, and performance monitoring.
Oversee risk adjustment data submission, validation, analytics, documentation, audit readiness, and remediation.
Provide executive oversight of delegated medical group risk adjustment strategies and performance accountability.
Direct performance reporting and analytics for operational, medical group, physician, executive, and Board-level decisions.
Conduct actuarial and financial analyses supporting product development, growth opportunities, provider reimbursement arrangements, and strategic initiatives.
Evaluate delegated-risk, capitated, and value-based reimbursement arrangements and their financial impact.
Present findings and recommendations to executive leadership and business stakeholders.
Lead actuarial support for California large group rate filings and regulatory inquiries.
Support regulatory submissions, audits, surveys, financial reporting, risk adjustment, and medical loss ratio reporting.
Ensure actuarial and underwriting activities comply with regulations and Actuarial Standards of Practice.
Supervise, mentor, and develop actuarial, underwriting, and risk adjustment staff.
Establish priorities, review work products, ensure timely deliverables, expand internal capabilities, improve processes, and develop automation and reporting tools.

Requirements

What you’ll need

Bachelor's Degree Actuarial Science, Mathematics, Statistics, Finance, Economics, or a related quantitative field
8 Years Progressive health actuarial experience including pricing, forecasting, underwriting, risk adjustment, financial analytics, or related actuarial functions in a health plan, managed care, health insurance, or healthcare consulting environment.
5 Years Leadership or management experience with accountability for professional staff, complex work products, cross-functional initiatives, and strategic business decisions.
3 Years Experience supporting commercial health plan products, rate development, underwriting, pricing, and regulatory filings.
3 Years Experience preparing, reviewing, or overseeing actuarial analyses, financial forecasts, regulatory exhibits, actuarial models, or actuarial certifications.
Associate of the Society of Actuaries (ASA) - Society of Actuaries (SOA) -REQUIRED
Member of the American Academy of Actuaries (MAAA) - REQUIRED
Advanced knowledge of health insurance, managed care, and healthcare finance principles.
Advanced knowledge of actuarial methodologies, financial modeling, forecasting, pricing, underwriting, and risk assessment.
Advanced knowledge of risk adjustment programs, coding and documentation practices, and related regulatory requirements.
Knowledge of healthcare reimbursement methodologies, including capitation, shared savings, value-based reimbursement, and delegated-risk arrangements.
Knowledge of healthcare regulations, actuarial standards of practice, rate filings, regulatory reporting, and audit requirements.
Advanced proficiency with Microsoft Excel and financial analytics tools.
Strong organizational, project management, problem-solving, and decision-making skills.
Preferred: 3 Years Experience with ACA risk adjustment, CMS programs, provider risk arrangements, capitation, value-based payment models, or delegated-risk operations.
Fellow of Society of Actuaries (FSA) - PREFERRED