Chief Actuary, Jefferson Health Plans

Philadelphia, PA - USA

Monthly Salary: Not Disclosed

Posted on: 2 days ago

Vacancies: 1 Vacancy

Job Summary

Job Details

We are seeking a Chief Actuary to lead the actuarial strategy and execution across our government-sponsored health programs including Medicaid Medicare CHIP and ACA. This executive will serve as a key member of the leadership team responsible for driving pricing strategy reserving accuracy and trend analytics that support sustainable growth and financial performance.

The ideal candidate will bring deep technical expertise a strong command of regulatory environments and a collaborative leadership style to influence enterprise-wide decisions. This role also includes evaluating and optimizing the balance between internal actuarial capabilities and external consulting support particularly for ACA and Medicare pricing functions.

Essential Functions:

Interacts with co-workers visitors and other staff consistent with the values of Jefferson.

Strategic Pricing Leadership

Own and oversee pricing strategy and rate development for Medicare and ACA products ensuring competitiveness and compliance with regulatory requirements.

o Evaluate and rationalize the division of pricing responsibilities between
internal actuarial teams and external consultants particularly for ACA and
Medicare lines of business.

o Develop a roadmap to transition appropriate pricing functions in-house where
it adds strategic value enhances agility or improves cost-efficiency while
maintaining strong oversight of consultant-delivered work.

o Ensure pricing methodologies are actuarially sound data-driven and aligned
with both regulatory expectations and enterprise financial goals.

Reserving and Forecasting

Lead the development of actuarial reserves and financial forecasts ensuring accuracy transparency and alignment with corporate financial goals.

Trend analysis and insights

Analyze medical cost trends and utilization patterns to inform business strategy product design and cost containment initiatives.

Cross Functional Collaboration

Partner with Finance Clinical Product and Regulatory teams to translate actuarial insights into actionable business strategies.

Regulatory Engagement

Serve as the actuarial point of contact for state and federal regulators ensuring timely and accurate submissions and responses.

Team Leadership and Development

Build lead and mentor a high-performing actuarial team with a focus on recruiting top talent and expanding internal capabilities. Foster a culture of innovation accountability and continuous improvement to support the organizations long-term growth and self-sufficiency.

Data driven decision making

Champion the use of advanced analytics and predictive modeling to enhance pricing accuracy and operational efficiency.

Strategic Pricing Leadership

Own and oversee pricing strategy and rate development for Medicare and ACA products ensuring competitiveness and compliance with regulatory requirements.

Job Description

Education Required:

Bachelors degree in actuarial science mathematics statistics or related field
(Masters preferred.)

FSA (Fellow of the Society of Actuaries) designation required.

Experience Required:

10 years of actuarial experience in health insurance with significant

leadership in government programs (Medicaid Medicare CHIP ACA).

Competencies (Knowledge Skills and Abilities Required):

Proficient in actuarial modeling software (e.g. SQL SAS R Python Excel
VBA).

Experience in building or reviewing models related to pricing reserving and
risk adjustment.

Proven track record in pricing reserving and trend analysis.

Strong understanding of regulatory frameworks and rate filing processes.

Exceptional leadership communication and stakeholder management skills.

Experience working in a matrixed or highly collaborative organizational
structure.

Strategic thinker with the ability to translate complex data into business
insights.

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Work Shift

Workday Day (United States of America)

Worker Sub Type

Regular

Employee Entity

Health Partners Plans Inc.

Primary Location Address

1101 Market Philadelphia Pennsylvania United States of America

Nationally ranked Jefferson which is principally located in the greater Philadelphia region Lehigh Valley and Northeastern Pennsylvania and southern New Jersey is reimagining health care and higher education to create unparalleled value. Jefferson is more than 65000 people strong dedicated to providing the highest-quality compassionate clinical care for patients; making our communities healthier and stronger; preparing tomorrows professional leaders for 21st-century careers; and creating new knowledge through basic/programmatic clinical and applied research. Thomas Jefferson University home of Sidney Kimmel Medical College Jefferson College of Nursing and the Kanbar College of Design Engineering and Commerce dates back to 1824 and today comprises 10 colleges and three schools offering 200 undergraduate and graduate programs to more than 8300 students. Jefferson Health nationally ranked as one of the top 15 not-for-profit health care systems in the country and the largest provider in the Philadelphia and Lehigh Valley areas serves patients through millions of encounters each year at 32 hospitals campuses and more than 700 outpatient and urgent care locations throughout the region. Jefferson Health Plans is a not-for-profit managed health care organization providing a broad range of health coverage options in Pennsylvania and New Jersey for more than 35 years.

Jefferson is committed to providing equal educational and employment opportunities for all persons without regard to age race color religion creed sexual orientation gender gender identity marital status pregnancy national origin ancestry citizenship military status veteran status handicap or disability or any other protected group or status.

Benefits

Jefferson offers a comprehensive package of benefits for full-time and part-time colleagues including medical (including prescription) supplemental insurance dental vision life and AD&D insurance short- and long-term disability flexible spending accounts retirement plans tuition assistance as well as voluntary benefits which provide colleagues with access to group rates on insurance and discounts. Colleagues have access to tuition discounts at Thomas Jefferson University after one year of full time service or two years of part time service. All colleagues including those who work less than part-time(including per diemcolleagues adjunct faculty and Jeff Temps) have access to medical (including prescription) insurance.

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Required Experience:

Chief

Job DetailsWe are seeking a Chief Actuary to lead the actuarial strategy and execution across our government-sponsored health programs including Medicaid Medicare CHIP and ACA. This executive will serve as a key member of the leadership team responsible for driving pricing strategy reserving accurac...