Senior Director, Actuary

Role Scope: 

We are looking for Senior Director, Actuary to serve as a critical analytics partner to the business, developing and maintaining advanced forecast models for risk adjustment, Incurred But Not Reported (IBNR) reserving, and medical claims planning. This role will collaborate with finance, clinical, and operational teams to deliver actionable insights that drive strategic decision-making, optimize financial performance, and ensure compliance with regulatory authorities. Responsibilities for the role will include: 

• Risk Adjustment Processes:
  • Develop and refine predictive models for risk adjustment scores, leveraging demographic, clinical, and claims data to ensure revenue accuracy per CMS guidelines.
  • Support annual and quarterly forecasting processes for risk adjustment projections and monthly accruals with Population Health, Health Plan, and Finance teams.
  • Analyze results to provide variance explanations and recommend adjustments to improve forecast accuracy.
• IBNR Processes:
  • Design and implement actuarial models to estimate IBNR liabilities, ensuring reserves are accurate and in compliance with all relevant regulatory standards.
  • Continually monitor and validate IBNR reserves, providing insights into monthly trends and proactively recommending necessary adjustments to Finance leadership.
• Strategic Analytics & Forecasting:
  • Analyze medical claims data to identify key cost drivers, utilization patterns, and operational trends, developing predictive models to forecast claims expenses.
  • Partner with clinical and operational teams to surface insights that inform care optimization strategies.
  • Utilize public and proprietary data sources to create medical claims forecasts for new markets and to inform planning in existing markets.
  • Partner with finance and data teams to execute and continuously improve standardized monthly reporting processes for risk adjustment, IBNR, and claims analytics.
  • Develop and maintain dashboards and reporting tools to track key performance indicators (KPIs) related to financial and clinical outcomes.
  • Assist in the preparation and submission of regulatory reporting packages to ensure compliance with CMS and state requirements.
• Process Improvement:
  • Drive process improvements and automation within data analytics and actuarial workflows to increase efficiency and model accuracy.
  • Collaborate cross-functionally to ensure alignment and consistency in data processes, modeling methodologies, and reporting.

Experience that drives success in this role:  

• 7-10+ years of experience, with at least 5+ years in actuarial analysis, or a related role in a Medicare Advantage, Medicaid, or related risk-bearing healthcare business.
• Data-driven mindset with strong analytical skills to develop, validate, and optimize predictive models and track performance metrics.
• Ability to lead with influence and collaborate across functions.
• Clear understanding of Medicare Advantage risk adjustment (HCC coding, RAF scores), IBNR methodologies, and medical claims analytics.
• Comfort with ambiguity and change often experienced in a startup environment.
• Aligns with our purpose and our values, and is excited about living those out in daily practice. 

Preferred Qualifications:  

•  Actuarial credentials (e.g., Associate of the Society of Actuaries (ASA) or progress toward certification) are a plus but not required.
• Proficiency in programming languages such as Python, R, or SQL for data analysis and modeling; experience with data visualization tools (e.g., Tableau, Power BI) is a plus.
• Extensive knowledge of Excel; familiarity with Enterprise Financial Planning or actuarial software (e.g., NetSuite/Sage, SAS, Milliman tools) is preferred.

Compensation & Benefits:  

We take into account an individual’s geographic location, qualifications, skillset, and experience in determining final salary. This role is eligible for medical/dental/vision insurance, short and long-term disability, life insurance, flexible spending accounts, 401(k) savings, paid time off, and company-paid holidays. The expected salary range for this position is $183,000 - $220,000 and is eligible for a bonus. The actual offer will be at the company’s sole discretion and determined by relevant business considerations, including the final candidate’s qualifications, years of experience, skillset, and geographic location.  

Vaccination Policy, including COVID-19 

At Habitat Health, we aim to provide safe and high-quality care to our participants. To achieve this, please note that we have vaccination policies to keep both our team members and participants safe. For covid and flu, we require either proof of vaccination or declination form and required masking while in participant locations as a safe as and essential requirement of this role.  Requests for reasonable accommodations due to an applicant’s disability or sincerely held religious beliefs will be considered and may be granted based upon review. We also require that team members adhere to all infection control, PPE standards and vaccination requirements related to specific roles and locations as a condition of employment. 

Our Commitment to Diversity, Equity, and Inclusion: 

Habitat Health is an equal opportunity employer committed to creating a diverse and inclusive workplace. Habitat Health applicants are considered solely based on their qualifications, without regard to race, color, religion, creed, sex, gender (including pregnancy, childbirth, breastfeeding or related medical conditions), gender identity, gender expression, sexual orientation, marital status, military or veteran status, age, national origin, ancestry, citizenship, physical or mental disability, medical condition, genetic information or characteristics (or those of a family member), or other status protected by applicable law. 

Habitat Health is committed to the full inclusion of all qualified individuals. In keeping with our commitment, Habitat Health will take steps to provide people with disabilities and sincerely held religious beliefs with reasonable accommodations in accordance with applicable law.  Accordingly, if you require a reasonable accommodation to fully participate in the job application or interview process, to perform the essential functions of the position, and/or to receive all other benefits and privileges of employment, please contact us at careers@habitathealth.com. 

Beware of Scams and Fraud 

Please ensure your application is being submitted through a Habitat Health sponsored site only. Our emails will come from @habitathealth.com email addresses. If you feel that you have been the victim of a scam such as this, please report the incident to the Federal Trade Commission by selecting the ‘Rip-offs and Imposter Scams’ option: https://reportfraud.ftc.gov/#/.