[Remote] Medicare Advantage Pricing Actuary

Note: The job is a remote job and is open to candidates in USA. Devoted Health is hiring a Pricing Actuary to lead the strategy, modeling, and execution of its annual Medicare Advantage bids. The role oversees bid submissions, pricing and assumptions, regulatory compliance, and cross-functional coordination across finance, clinical, product, and operational teams.

Responsibilities

• Annual Bid Leadership: Direct and oversee the end-to-end development, modeling, and submission of annual Medicare Advantage (Part C and Part D) bids, ensuring total compliance with CMS guidelines and strict adherence to statutory deadlines
• Product & Benefit Pricing Strategy: Partner with product, clinical, and local market leaders to design competitive benefit packages, evaluating product trade-offs, supplemental benefits, and cost-sharing mechanics against financial and growth targets
• Assumption Development: Establish, defend, and document core actuarial bid assumptions, including baseline utilization, unit cost trends, risk adjustment factors, administrative expense allocations, and margin targets
• Actuarial Modeling & Automation: Build, refine, and maintain scalable bid pricing models, ensuring high standards of technical accuracy, model governance, and repeatable execution across expanding market footprints
• Sensitivity & Scenario Analysis: Perform complex scenario testing and sensitivity analyses to quantify the financial impacts of proposed CMS payment policy changes, risk model updates, benchmark shifts, and competitive market dynamics
• CMS Regulatory Translation: Interpret annual CMS Call Letters, Bid Instructions, and Rate Announcements, translating regulatory changes into actionable modeling adjustments and executive strategic guidance
• Cross-Functional Partnership: Work seamlessly across Finance, Healthcare Economics, Clinical Operations, and Network Management to ensure bid assumptions reflect actual operational capabilities, clinical programs, and provider contracting terms
• Data Integration & Quality Assurance: Partner closely with data engineering and analytics teams to ensure the integrity, completeness, and accuracy of historical claims, enrollment, and risk adjustment data fed into bid models
• Executive & Regulatory Presentation: Prepare clear, compelling executive-level presentations summarizing bid strategy, financial returns, and risk profiles for executive leadership, board members, and regulatory reviewers

Skills

• 8+ years of progressive healthcare actuarial experience, with at least 5+ years of deep, direct focus on Medicare Advantage bid pricing, plan design, and CMS bid submission
• Demonstrated ability to consistently drive complex, time-sensitive projects to completion on schedule, managing high-stakes regulatory deadlines with poise and precision
• Advanced proficiency in actuarial modeling, claims data extraction, and financial modeling tools (e.g., SQL, Python, R, SAS, or advanced Excel modeling)
• Thorough understanding of Medicare Advantage pricing mechanics, including Part D direct subsidy/benefit design, CMS risk adjustment models (CMS-HCC, RxHCC), Star Ratings financial impacts, and benchmark calculations
• Exceptional interpersonal skills with a proven track record of working constructively across cross-functional teams, translating complex actuarial concepts into clear strategic choices for non-actuarial partners
• Experience interfacing with reserving, underwriting, risk adjustment operations, or medical economics functions
• Comfort operating in a fast-paced, high-growth environment where processes are continuously refined and optimized
• Associate (ASA) or Fellow (FSA) of the Society of Actuaries, and Member of the American Academy of Actuaries (MAAA). Fully equivalent experience and bid leadership track record will be strongly considered

Benefits

• Employer sponsored health, dental and vision plan with low or no premium
• Generous paid time off
• $100 monthly mobile or internet stipend
• Stock options for all employees
• Bonus eligibility for all roles excluding Director and above
• Commission eligibility for Sales roles
• Parental leave program
• 401K program

Company Overview