CrawlJobs Logo

Executive Director, Actuarial

hcsc.com Logo

Health Care Service Corporation

Location Icon

Location:
United States , Chicago

Category Icon
Category:

Job Type Icon

Contract Type:
Not provided

Salary Icon

Salary:

161500.00 - 299700.00 USD / Year

Job Description:

The Executive Director, Medicare Part D Actuarial will lead the actuarial function for Medicare Part D products, including Individual MAPD and PDP, with end-to-end accountability for product strategy, pricing, and financial performance. The Executive Director provides actuarial leadership across product strategy, benefit design, formulary and pharmacy network strategies, and is responsible for Medicare Part D bid development and submission, quarterly forecasting, monthly close support, and bid audits. This position reports to the DSVP, Pharmacy Finance and Actuarial and serves as a key strategic partner to senior leaders across Pharmacy, Product, Finance, Compliance, and Operations. The role also acts as the primary actuarial point of contact for external vendors and consultants.

Job Responsibility:

  • Lead actuarial strategy for Individual MAPD and PDP products, ensuring financial sustainability, regulatory compliance, and competitive market positioning
  • Provide actuarial leadership on product strategy and component strategies, including benefits, formulary, rebate, network, and mail, balancing affordability, growth, and margin objectives
  • Partner cross-functionally with Pharmacy, Product, Finance, Compliance, and Operations to align actuarial assumptions with enterprise strategy
  • Oversee end-to-end Medicare Part D bid development and submission, including pricing, assumptions, documentation, and internal governance approvals
  • Lead quarterly forecast updates and support monthly close activities, ensuring accuracy, transparency, and alignment between actuarial projections and financial results
  • Provide actuarial support for annual PBM market checks and negotiations
  • Identify key financial risks and opportunities, proactively communicating insights and recommendations to executive leadership
  • Lead Medicare Part D market intelligence, including competitor analysis, CMS policy changes, regulatory guidance, and industry trends
  • Translate market insights into actionable recommendations for product design, pricing strategy, and long-term Medicare positioning
  • Serve as actuarial lead for CMS bid audits, internal audits, and financial audits, ensuring defensibility of assumptions, data integrity, and timely responses
  • Establish and maintain strong actuarial governance, controls, and documentation standards to support regulatory and audit requirements
  • Act as the primary actuarial point of contact for external actuarial vendors and consultants
  • Oversee vendor scope, deliverables, timelines, and quality, ensuring alignment with business objectives and regulatory expectations
  • Leverage external partnerships to enhance modeling sophistication, analytics, and strategic decision-making
  • Lead, mentor, and develop a high-performing actuarial team supporting Medicare Part D
  • Foster a culture of accountability, collaboration, and continuous improvement, with a focus on developing future actuarial leaders
  • Set clear priorities, performance expectations, and development plans aligned with organizational goals

Requirements:

  • Bachelor’s degree in business, Finance, Actuarial Science, Mathematics, Economics, Computer Science or Management Information Systems
  • 10 years of data, transactional application-based knowledge or group health underwriting experience
  • 10 years of management experience, including overseeing two or more departments led by managers
  • Experience in leading one or more major (multi year) group insurance implementation projects
  • Experience in leading one of the following: Actuarial Systems or Applications and systems related teams including testing, building, and writing requirements
  • Experience in quality and auditing and system testing (including creating test scripts)
  • Experience planning skills including: Setting goals at a position appropriate level, long term planning (one year or longer), budget and expense management, creating staffing models for up to 2 years, establishing department vision
  • Problem solving, negotiation skills, and organizational alignment
  • Clear and concise verbal and written communication skills. Experience presenting to all levels of management including audiences with diverse communications preferences
  • Overseeing the annual budget and allocating resources for various projects and operational needs
  • Translating needs and initiatives into compelling business cases
  • Conducting cost-benefit analyses to justify investments and ensure ROI

Nice to have:

  • Bachelor’s degree in Actuarial Science, Mathematics, Statistics, Economics, or a related field
  • advanced degree preferred
  • FSA designation
  • 10+ years of progressive actuarial experience, including significant leadership responsibility in Medicare Part D
  • Deep expertise in Medicare Part D pricing, bid development, forecasting, and regulatory requirements
  • Strong strategic influence, executive presence, and financial acumen
  • Strong understanding of pharmacy benefit economics, including formulary and network strategy impacts
  • Proven experience leading CMS bid audits and financial audits, and partnering with external actuarial firms
  • Demonstrated ability to communicate complex actuarial and financial concepts clearly to senior leaders and non-technical stakeholders

Additional Information:

Job Posted:
January 09, 2026

Employment Type:
Fulltime
Work Type:
Hybrid work
Job Link Share:

Looking for more opportunities? Search for other job offers that match your skills and interests.

Briefcase Icon

Similar Jobs for Executive Director, Actuarial

Director, Value-Based Analytics & Actuarial Strategy

SpectraMedix is seeking an accomplished professional with an actuarial or advanc...
Location
Location
United States , NJ
Salary
Salary:
Not provided
spectramedix.com Logo
SpectraMedix
Expiration Date
Until further notice
Flip Icon
Requirements
Requirements
  • Bachelor’s or Master’s degree in Actuarial Science, Statistics, Mathematics, Health Economics, or related field
  • 12+ years of experience in actuarial, financial, or value-based analytics roles within a consulting firm, health plan, ACO, or healthcare analytics organization
  • Proven understanding of value-based contracting, risk adjustment, quality metrics, and payment reconciliation processes
  • Strong data literacy—experience working with healthcare data (claims, cost, quality, utilization) and proficiency with analytical tools (SQL, R, Python, Excel, Power BI, etc.)
  • Excellent communication skills with the ability to engage payer and provider executives and translate complex analytics into actionable strategy
  • This role involves approximately 20–25% travel, so you should be comfortable with occasional work-related travel
  • Hands-on exposure to Cloud technologies, particularly Azure, AWS, and Databricks
Job Responsibility
Job Responsibility
  • Partner with health plans, ACOs, and health systems to design, evaluate, and enhance value-based care programs (e.g., shared savings, global capitation, incentive models)
  • Lead actuarial and financial analytics supporting contract modeling, risk adjustment, benchmarking, and performance measurement across multiple lines of business (Medicaid, Medicare, Commercial)
  • Translate analytical findings into strategic insights for clients—supporting contract development, performance improvement, and program optimization
  • Collaborate with internal teams (product, engineering, and client delivery) to shape product strategy and ensure that data-driven capabilities align with evolving market needs
  • Serve as a client-facing subject matter expert in value-based contracting, risk modeling, and performance analytics
  • Assist clients with defining their value-based strategy and defining an ROI
  • Contribute to business development activities by supporting client presentations, proposals, and thought leadership initiatives
  • Stay current with CMS, state Medicaid, and commercial VBP policy trends, including interoperability and quality measurement standards (HEDIS, eCQMs, DaVinci, MCP, etc.)
  • Be a strategic thought leader within the Company to help scale SpectraMedix into the leader in VBC software applications
What we offer
What we offer
  • Competitive compensation, benefits, and professional growth opportunities
Read More
Arrow Right

Executive Director, Client Marketing Initiatives

The Executive Director, Client Marketing Initiatives is responsible for leading ...
Location
Location
United States of America , Chesterfield, Missouri
Salary
Salary:
123500.00 - 184050.00 USD / Year
Reinsurance Group of America
Expiration Date
Until further notice
Flip Icon
Requirements
Requirements
  • Bachelor’s Degree in Arts/Sciences (BA/BS) in marketing or related field required
  • 15+ Years of experience and demonstrated leadership in marketing strategy and business development support, including working with a life/health insurance or financial services company required
  • 6+ Years of technical / insurance / reinsurance marketing experience required
  • Marketing leadership experience required
  • 5+ Years of experience working directly with executive leadership required
  • Advanced business acumen and deep subject matter expertise in marketing and business development practices. required
  • Demonstrated ability to provide tangible and effective support resulting in the achievement of business growth strategy objectives. required
  • Highly advanced oral and written communication skills, demonstrating the ability to be persuasive and convey sophisticated business concepts and to all stakeholders, including clients, vendors, and internal associates at all management levels. required
  • Comfortable working in a fast-paced environment and ability to manage multiple priorities and deadlines at once. required
  • Highly advanced ability to foster teamwork and implement change, employing advanced project management methodologies and delegating key responsibilities to other project team members. required
Job Responsibility
Job Responsibility
  • Collaborate with RGA Americas business leadership and account teams to identify complex business challenges and opportunities, translate them into appropriate marketing solutions, secure necessary resources, and lead program implementation
  • Direct cross-functional project teams to implement and execute targeted client campaigns while maximizing the value to RGA, delivering on the needs of business development, pricing, underwriting, actuarial services, underwriting services, operations, and other functional areas within the Americas regional business lines
  • Develop and amplify key messages for the Americas region through the curation and targeted dissemination of content marketing programs and strategic growth-focused campaigns, inclusive of the development, packaging, positioning, and launching of new services, solutions, and capabilities
  • Identify new, innovative ways to increase client engagement, which includes responsibility for the implementation and success measurement of those efforts
  • Curate and maintain execution plans for campaigns that clearly articulate their fit with global and regional strategies and demonstrate progress with established project success factors and other key performance indicators
  • Maintains regular and predictable attendance
  • Performs other duties as assigned
What we offer
What we offer
  • Gain valuable knowledge from and experience with diverse, caring colleagues around the world
  • Enjoy a respectful, welcoming environment that fosters individuality and encourages pioneering thought
  • Join the bright and creative minds of RGA, and experience vast, endless career potential
  • RGA provides an annual bonus plan that includes all roles and some positions are eligible for participation in our long-term equity incentive plan
  • RGA also maintains a full range of health, retirement, and other employee benefits
  • Fulltime
Read More
Arrow Right

Senior Director, Insurance AI Innovation & GTM Advisory

The Senior Director, Insurance AI Innovation & GTM Advisory will lead the commer...
Location
Location
Canada
Salary
Salary:
158000.00 - 294000.00 CAD / Year
nttdata.com Logo
NTT DATA
Expiration Date
Until further notice
Flip Icon
Requirements
Requirements
  • Bachelor's degree in a relevant technical field (e.g., Computer Science, Engineering, Actuarial Science)
  • Deep Insurance Domain Expertise: Extensive experience working within the P&C or L&A insurance industries, with a strong understanding of core value chains (underwriting, policy servicing, claims)
  • GTM & Commercial Acumen: Proven track record in a GTM, product marketing, or solutions engineering role for a technical product sold into the financial services/insurance sector
  • Strong Technical Background: Proficiency in software engineering principles, including Python, APIs, SQL, and data pipelines. Experience delivering production-ready technical solutions within enterprise environments is essential
  • AI Knowledge: Deep understanding of agentic AI frameworks, Large Language Models (LLMs), and how they can be practically applied to solve insurance business challenges
  • Client-Facing Skills: Excellent communication skills with the ability to build trust and translate complex technical concepts into clear business value for executive and technical stakeholders alike
Job Responsibility
Job Responsibility
  • Develop and execute a tailored GTM strategy for the P&C and L&A sectors, identifying key use cases (e.g., automated claims routing, risk assessment automation) and defining targeted value propositions
  • Collaborate with marketing, sales, product, and engineering teams to build differentiating capabilities and revenue-driving initiatives
  • Develop compelling, industry-specific collateral, case studies, and demos that resonate with insurance professionals
  • Analyze insurance industry trends and competitive landscapes to ensure our platform maintains a leading edge in functionality and compliance
  • Collaborate directly with senior client stakeholders to understand specific P&C/L&A infrastructure and pain points, architecting bespoke AI solutions
  • Serve as the subject matter expert for defining workflows—underwriting, claims, policy admin, actuarial, billing, customer service, agent engagement, fraud, and compliance
  • Lead the end-to-end delivery of complex AI solutions within client environments
  • Act as the primary technical advisor, guiding clients through the complexities of deploying novel AI solutions while navigating compliance and data privacy requirements
  • Provide actionable, domain-specific feedback to internal Product and Engineering teams to refine the platform roadmap for the insurance vertical
What we offer
What we offer
  • Company benefits may include medical, dental, and vision insurance, flexible spending or health savings account, life, and AD&D insurance, short-and long-term disability coverage, paid time off, employee assistance, participation in retirement savings programs, and additional voluntary or legally required benefits
  • Fulltime
Read More
Arrow Right

Director, Payment Integrity

The Director, Payment Integrity provides strategic leadership and oversight for ...
Location
Location
United States , Phoenix
Salary
Salary:
Not provided
azblue.com Logo
Blue Cross Blue Shield of Arizona
Expiration Date
Until further notice
Flip Icon
Requirements
Requirements
  • 10 years of experience in Payment Integrity, Special Investigation Unit, or healthcare anti-fraud
  • 7+ years of experience in management role
  • 2+ years of experience in Vendor Partner Oversight
  • contracting and vendor management of external payment vendors and/or audit firms
  • Demonstrated success in developing and executing enterprise-wide strategies
  • Bachelor's Degree in business, statistics, healthcare administration or related field of study
  • Intermediate PC proficiency
  • Intermediate skill in use of office equipment
  • Basic skill in word processing and presentation software
  • Intermediate proficiency in spreadsheet, statistical analysis, query / data mining, and business intelligence software
Job Responsibility
Job Responsibility
  • Develop and execute enterprise-wide Payment Integrity strategy aligned with organizational objectives and cost of care targets
  • Lead the design, implementation, and continuous improvement of payment integrity programs, including pre- and post-payment audits, recovery, and investigative functions
  • Establish and maintain governance structures, including cross-functional committees, to oversee payment integrity controls and policy development
  • Representing the organization in internal and external forums, collaborating with industry peers, regulatory bodies, and vendor partners to share best practices and drive innovation
  • Stay abreast of emerging trends, technologies, and regulatory shifts in the healthcare payment integrity space
  • Oversee day-to-day operations, ensuring timely, accurate, and compliant claims payment and recovery activities
  • Direct vendor management, including contracting, performance oversight, and strategic partnerships for payment integrity solutions
  • Drive automation and technology adoption to enhance payment integrity processes and reporting capabilities
  • Lead cost-benefit analyses to determine optimal resource allocation (internal vs. outsourced functions)
  • Set and monitor KPIs, SMART goals, and financial targets for payment integrity initiatives
  • Fulltime
Read More
Arrow Right

Director, Payment Integrity

The Director, Payment Integrity provides strategic leadership and oversight for ...
Location
Location
United States , Phoenix
Salary
Salary:
Not provided
azblue.com Logo
Blue Cross Blue Shield of Arizona
Expiration Date
Until further notice
Flip Icon
Requirements
Requirements
  • 10 years of experience in Payment Integrity, Special Investigation Unit, or healthcare anti-fraud
  • 7+ years of experience in management role
  • 2+ years of experience in Vendor Partner Oversight
  • contracting and vendor management of external payment vendors and/or audit firms
  • Demonstrated success in developing and executing enterprise-wide strategies
  • Bachelor's Degree in business, statistics, healthcare administration or related field of study
  • Intermediate PC proficiency
  • Intermediate skill in use of office equipment
  • Basic skill in word processing and presentation software
  • Intermediate proficiency in spreadsheet, statistical analysis, query / data mining, and business intelligence software
Job Responsibility
Job Responsibility
  • Develop and execute enterprise-wide Payment Integrity strategy aligned with organizational objectives and cost of care targets
  • Lead the design, implementation, and continuous improvement of payment integrity programs, including pre- and post-payment audits, recovery, and investigative functions
  • Establish and maintain governance structures, including cross-functional committees, to oversee payment integrity controls and policy development
  • Representing the organization in internal and external forums, collaborating with industry peers, regulatory bodies, and vendor partners to share best practices and drive innovation
  • Stay abreast of emerging trends, technologies, and regulatory shifts in the healthcare payment integrity space
  • Oversee day-to-day operations, ensuring timely, accurate, and compliant claims payment and recovery activities
  • Direct vendor management, including contracting, performance oversight, and strategic partnerships for payment integrity solutions
  • Drive automation and technology adoption to enhance payment integrity processes and reporting capabilities
  • Lead cost-benefit analyses to determine optimal resource allocation (internal vs. outsourced functions)
  • Set and monitor KPIs, SMART goals, and financial targets for payment integrity initiatives
  • Fulltime
Read More
Arrow Right

Senior Director, Benefits

The Senior Director, Benefits will lead the design, development, and execution o...
Location
Location
United States
Salary
Salary:
147000.00 - 256300.00 USD / Year
https://www.marriott.com Logo
Marriott Bonvoy
Expiration Date
Until further notice
Flip Icon
Requirements
Requirements
  • Bachelor’s degree or equivalent experience, plus 10+ years’ of diverse benefits leadership experience program with a history of progressive responsibility managing the benefits function within a large, global organization
  • Demonstrated technical depth in U.S. Benefits, with experience redesigning legacy programs applying innovative thinking and a willingness to work in the details
  • Skilled in stakeholder management, as well as proven ability to build and facilitate relationships and influence others at all levels of the organization, both internally and externally
  • Strong decision-making and organizational skills, with the ability to optimize the use of all available resources and deliver on multiple priorities
Job Responsibility
Job Responsibility
  • Partner with Total Rewards and Benefits leadership to develop and execute the benefits strategy
  • Influence senior leadership across the company to ensure support for and alignment around programs that have an impact on company performance (e.g. revenue management, workforce planning)
  • Manage diverse associate benefits and absence programs
  • Ensure benefits program materials and communications showcase Marriott’s Total Rewards programs and People First focus, leverage modern communication technologies and techniques, and resonate with a diverse population
  • Leverage data, insights, and trends to inform program design, strategy and performance measures
  • Manage vendor relationships, contractual terms and operations to deliver an exceptional experience and manage costs
  • Proactively stay current on industry best practices, legislative changes, and periodic market evaluations, to ensure programs are optimized, compliant and to develop recommendations for change
  • Collaborate with internal and external stakeholders to promote benefits programs, drive engagement, and support holistic well-being
  • Develop a cohesive, holistic health and wellbeing strategy to ensure Marriott offers a competitive benefits package and drives improvements in the wellbeing of associates and their families
  • Lead the planning, design, and implementation of all U.S. employee health, welfare and absence benefits plans, including, but not limited to, health, dental, vision, life and disability insurance, leave of absence, and time off programs
What we offer
What we offer
  • bonus program
  • comprehensive health care benefits
  • 401(k) plan with up to 5% company match
  • employee stock purchase plan at 15% discount
  • accrued paid time off (including sick leave where applicable)
  • life insurance
  • group disability insurance
  • travel discounts
  • adoption assistance
  • paid parental leave
  • Fulltime
Read More
Arrow Right
New

Safety Intern

Join Lhoist North America’s dynamic internship program and gain hands-on experie...
Location
Location
United States , Calera
Salary
Salary:
Not provided
lhoist.com Logo
Lhoist
Expiration Date
Until further notice
Flip Icon
Requirements
Requirements
  • Strong analytical skills
  • Open to feedback and eager to learn
  • Proactive and positive approach to work
  • Effective communication skills, both oral and written
  • High learning agility
  • English is mandatory
  • Willingness to travel if necessary
Job Responsibility
Job Responsibility
  • Tackle Real Projects: Dive into projects outlined by management and be ready to adapt to new challenges
  • Learn and Grow: Seek out work and learning opportunities proactively
  • Communicate Like a Pro: Engage with various levels of the organization and keep your manager/mentor updated on your progress
  • Improve Processes: Work efficiently and effectively to help improve processes at your location
  • Embrace Our Culture: Live our values of Respect, Integrity, and Courage. Work safely, especially around heavy equipment, and be a valued team member
  • Showcase Your Work: Present your project overview to Senior Leaders and local management at the end of the program
  • Stay Curious: Be eager to learn new skills and participate in all intern program activities (orientation, mid-term session, closing session, etc.)
  • Get There: Ensure you can transport yourself to and from the work location
  • And More: Take on other duties as assigned
What we offer
What we offer
  • Comprehensive medical, dental, vision, life, and disability insurance
  • Paid vacation and sick time
  • Attractive 401(k) Retirement Savings Plan with a generous Employer Match
  • Supplemental Contribution based on your Years of Service
  • Educational assistance
  • Fulltime
Read More
Arrow Right
New

Healthcare Assistant

Help us to deliver great primary care by improving access, outcomes and patient ...
Location
Location
United Kingdom , Nottingham
Salary
Salary:
26000.00 - 30000.00 GBP / Year
operosehealth.co.uk Logo
Operose Health
Expiration Date
February 20, 2026
Flip Icon
Requirements
Requirements
  • Experience in a Primary Care setting and phlebotomy is essential
  • Able to work within processes, procedures and maintain confidently and data security
  • Must be able to adapt with changing priorities and be personable, polite and patient with our patients
  • Must have basic PC skills such as Word, Excel and email
  • Ability to use own judgement and be aware of professional boundaries they are working to
Job Responsibility
Job Responsibility
  • Assisting with patient duties as required and support other team members such as clinical and Nurse Lead with patient care
  • Supporting the Practice with duties related to CQC outcomes and ensuring compliance is maintained
  • Working with patients with long term conditions such as Diabetes etc
  • Provide clinical procedures such as new patient health checks, BMI, blood pressure, pulse and simple wound care
  • Completing administrative tasks such as new patient registrations, providing appropriate leaflets, stock control and ordering
What we offer
What we offer
  • 27 days annual leave plus bank holidays pro rata
  • Access to our bespoke learning management system and annual formative clinical assessments to support competency development
  • The benefits of working with an at scale provider of primary care means that we lots of opportunities for our colleagues to specialise and develop
  • Car benefit scheme – specialising in electric vehicles
  • Cycle to work scheme
  • Travel season ticket loans
  • Discount cards
  • Employee wellbeing services including free yoga videos and employee wellbeing app
  • Parttime
Read More
Arrow Right