Senior Director, Actuarial Services

Summary

Join Tomorrow Health as a Senior Director of Actuarial Services, reporting to the VP, Chief Actuary. You will collaborate with various departments to drive data-driven decisions, support risk deal pricing, and enhance internal reporting. This role requires extensive experience in value-based care, strong analytical skills (R, SQL, SAS), and a deep understanding of healthcare data. You will be responsible for developing pricing models, analyzing claims data, and supporting forecasting efforts. The position offers a competitive salary, comprehensive benefits, and the opportunity to work remotely.

Requirements

• 8-10+ years of proven experience as an actuarial director in a healthcare setting, ideally with 5+ years of experience in value-based care at either a tier one Actuarial firm, tier one health plan, or post-acute/home based specialized care vendor
• Deep familiarity with government healthcare programs and policies, particularly Medicare, Medicare Advantage, Medicaid, and the Affordable Care Act
• Strong ability to communicate complex actuarial concepts and engage with various stakeholders,within Tomorrow Health and clients
• A strong record of collaboration with other leaders, including clinical and operations, to help drive business solutions
• Deep understanding and familiarity with claims data analytics and pricing model development for all lines of business (Medicare Advantage, Medicaid, Duals, Commercial and ACA Marketplace)
• Strong quantitative skills, including experience with statistical analysis and predictive modeling in healthcare contexts.  Deep experience with Excel, Tableau, SQL, ProVal, GGY, Axis, VBA, Access and other similar tools
• Associate-Level Certification from the Society of Actuaries or similar credential required
• Experience leading actuarial or similar function at an organization that is ‘at risk’ for the cost of medical care, such as an at risk provider system, payer, or contractor
• Proactive and results-oriented mindset, excelling in the rapid pace of startup environments
• Commitment to ethics and integrity

Responsibilities

• Develop product pricing models and underwriting process including relevant benchmarks
• Analyze CMS, State Medicaid, and Health Plan claims data files (all LOB) and alert team of any data concerns
• Work with Chief Actuary and external data/resources to help set appropriate trends for DME POS space
• Create applicable data models and aggregate, review, and analyze applicable data for various proposals and projects
• Devise, collect, maintain, and report financial and statistical information required to monitor cost and utilization trends for all products in order to assure accuracy of the factors and benchmarks used in the ratings and financial arrangements with health plans
• Track and project trend rates for all products across all lines of business, including Medicaid, Medicare Advantage, Duals, Commercial and ACA Marketplace
• Assist in Tomorrow Health’s forecasting efforts, including working with Finance, Operations, and other analytics teams
• Develop reserving process to enable appropriate risk accruals for financials
• Support chief actuary and product/sales team in negotiation process for new clients as well as settlements

Preferred Qualifications

• Exceptional skills with software such as R, SQL and/or SAS being able to analyze large amounts of payor data and are adept in building predictive models
• You also have a background in statistics and experience in evaluating the efficacy of programs

Benefits

• 100% employer-paid medical, dental and vision benefits
• HSA and FSA (Dependent Care and Commuter)
• Fully covered membership in One Medical for on-demand primary care, and Teladoc for 24/7 virtual care
• 12 weeks of paid parental leave for all caregivers
• Free mental health support with BetterUp through Health Advocate EAP
• Short-term, and long-term disability plan availability
• Company-sponsored Life and AD&D insurance
• Educational reimbursement
• Monthly wellness stipend
• Commuter Benefits
• Access to Vanguard 401k plan
• Unlimited vacation and 11 corporate holidays
• Compensation range for this position: $160,000 - $190,000/yr depending on experience and qualifications, plus equity
• Position can be remote