Take a leading role in shaping how healthcare value, savings, and financial performance are measured across innovative digital health programs. As a Principal Actuary, you will build internal actuarial capabilities and develop rigorous methodologies for pricing, return on investment (ROI), and performance guarantees. Working across Finance, Clinical, Commercial, and Strategy teams, you will translate complex healthcare data into actionable insights that support sustainable business growth. You will design and evaluate value-based arrangements, assess financial exposure, and help ensure commercial commitments are grounded in reliable evidence. This position combines hands-on modeling with strategic collaboration and direct engagement with payers, benefits consultants, and senior employer stakeholders. In a remote-first environment, you will have the autonomy to establish actuarial methodologies while collaborating with cross-functional partners on key business decisions. This is an exciting opportunity for an experienced healthcare actuary to influence healthcare economics, strengthen financial accountability, and help expand access to effective, outcomes-driven care.
Actuarial Strategy and ROI Methodology: Build and refine actuarial models that measure program savings, financial performance, and return on investment. Partner with Clinical and Commercial teams to develop ROI methodologies for Medicare and government markets, support Star Ratings analyses, and inform future program studies and evaluations.
Performance Guarantees and Risk Management: Design and price performance guarantees, shared-savings arrangements, and other at-risk commercial agreements. Develop pricing and exposure models, establish measurable performance triggers and contract terms, and define actuarial safeguards for customer commitments.
Claims-Based Analysis: Build defensible savings studies using medical and pharmacy claims data, including matched-cohort analyses. Ensure methodologies are robust, transparent, and capable of withstanding third-party scrutiny.
Commercial and Customer Engagement: Represent the actuarial function in finalist presentations, RFP processes, contract renewals, and discussions with payers, employers, benefits consultants, and external actuarial teams. Clearly communicate and defend analytical assumptions, measurement approaches, and financial trade-offs.
Portfolio Monitoring and Financial Reporting: Model and monitor performance guarantee exposure across the customer portfolio. Identify contracts with potential financial risk and provide appropriate accrual and reserve inputs to Accounting.
Pricing and Unit Economics: Evaluate pricing assumptions and unit economics, accounting for medical and pharmacy cost trends, GLP-1 utilization, specialty drug management, and other factors that may influence program economics and customer outcomes.
Model Governance and Documentation: Establish reusable, version-controlled actuarial models and maintain clear documentation of methodologies, assumptions, and validation procedures. Support audit requirements, external disclosures, and internal quality assurance.
Cross-Functional Partnership: Collaborate with Finance, Strategy, Clinical, and Commercial stakeholders to build actuarial understanding, inform business decisions, and ensure that analytical findings translate into practical recommendations.
Independent Technical Leadership: Set actuarial methodologies, assess the soundness of financial guarantees, and provide evidence-based recommendations. Work within established governance processes for final pricing decisions, contractual commitments, material risk acceptance, accounting conclusions, and external claims.
Analytical Innovation: Apply advanced analytical techniques and AI-enabled tools to improve modeling efficiency and insight generation, validating outputs and protecting confidential information throughout the process.