Director, Actuarial – Cross-Functional Operations
Transamerica
Senior Managing Actuary
TailorCare
full-time
Posted on:
Location: 🇺🇸 United States
Visit company websiteJob Level
Senior
Tech Stack
PythonSQL
About the role
- Serve as a senior actuarial expert, providing advanced analyses and recommendations that guide strategic decision-making across value-based care arrangements.
- Interpret and analyze data from multiple sources, including claims, provider, member, and encounters data, to identify and assess the business impact of trends.
- Anticipate and analyze industry trends, regulatory developments, and emerging methodologies, ensuring TailorCare remains competitive and prepared for market shifts.
- Lead the development and refinement of sophisticated forecasting, reserving, and pricing models, ensuring accuracy, scalability, and compliance with best practices.
- Create, enhance, and maintain advanced actuarial models that project MSK utilization, establish cost benchmarks, and quantify TailorCare’s cost savings.
- Integrate predictive analytics and, where appropriate, machine learning into model design to improve forecasting precision and risk assessment.
- Continuously monitor model performance, identifying and implementing enhancements to meet evolving client, regulatory, and internal requirements.
- Evaluate and provide actuarial recommendations on new and existing risk-based contracts, focusing on financial sustainability and performance optimization.
- Design and maintain risk mitigation strategies, including reserving, stop-loss, reinsurance, and contract-based mechanisms.
- Analyze contract performance and utilization trends, delivering actionable insights to improve outcomes and cost efficiency.
- Partner closely with finance, analytics, and operational teams to ensure alignment between actuarial insights and enterprise objectives.
- Mentor and provide technical review for actuarial associates and analysts, enhancing team capability and accuracy.
- Present complex analyses and recommendations to senior leadership with clarity and strategic relevance via monthly MLR reviews, quarterly financial reviews, etc.
- Develop and maintain rigorous standards for actuarial analysis, ensuring consistency, reliability, and transparency across all deliverables.
- Champion data integrity, collaborating with analytics teams to ensure accuracy and completeness of all actuarial data sources.
- Report on national, market, and deal-specific trends, translating findings into actionable recommendations.
Requirements
- Minimum of 8 years of actuarial experience in healthcare, focusing on pricing, claims trending, utilization management, underwriting, and/or benefits management analytics.
- Associate of the Society of Actuaries (ASA) is required
- Bachelor's or Master's degree in Actuarial Science, Mathematics, Statistics, or a related field required
- Proven ability to lead complex, cross-functional projects that deliver measurable business impact
- Advanced proficiency in SQL and/or Python with the ability to design, oversee, and validate complex analytics solutions.
- Forecasting experience in health care or insurance, preferably in value-based care
- Expertise in actuarial modeling, statistical analysis, and predictive analytics.
- Exceptional communication skills , with the ability to distill complex actuarial concepts into actionable insights for diverse audiences.
- Strong business acumen, analytical skills, and attention to detail with the ability to operate in a fast-paced, dynamic environment.
- Value-based care deal experience is a plus
- Healthcare or medical economics experience is a plus
