JOB SUMMARY

The Marketplace Lead Actuary will lead pricing strategy and rate filing development for ACA marketplace products while ensuring compliance with state and federal regulations. This role combines technical actuarial expertise with leadership and strategic business planning to drive sustainable growth in the individual market. In addition to rate filing, this role will support research and modeling for product expansion feasibility projects, research medical cost improvement opportunities, lead quarterly forecast, and support other ongoing and ad-hoc actuarial or analytics research.

JOB SPECIFICATIONS

• Lead annual rate filing development process for ACA marketplace products.
• Develop and maintain pricing models for individual market products.
• Analyze market dynamics, competitor positioning, and historical experience.
• Monitor and project risk adjustment transfer payments.
• Partner with Product and Network teams to optimize plan designs and provider arrangements.
• Ensure compliance with state and federal filing requirements.
• Present pricing recommendations to senior leadership.
• Coordinate with state regulators during rate review process.
• Monitor emerging experience and develop quarterly forecasts.
• Support organizational planning through market analysis and financial projections.

QUALIFICATIONS:

• Education/Specialized Training/Licensure: Bachelors Degree in Mathematics, Actuarial Science, or related field required. Associate of the Society of Actuaries (ASA) required.
• Fellow of the Society of Actuaries (FSA) preferred.
• Work Experience (Years and Area): 2+ years of Medicare Advantage pricing and bid development experience required.
• 5+ years of Actuarial experience required.
• 4+ years of Medicare Advantage pricing and bid development experience preferred.
• 7+ years of Actuarial experience prferred.
• Management Experience (Years and Area): 2+ years of management experience preferred.
• Software Proficiencies: Excel, SQL Excel, MS SQL Server

Other:

• Knowledge of risk adjustment methodologies
• Experience with actuarial modeling tools and marketplace pricing
• Strong analytical and problem-solving abilities.
• Excellence in project management and meeting deadlines.
• Outstanding communication skills with technical and non-technical audiences.
• Ability to influence and collaborate across departments.
• Strategic thinking and business acumen.
• Knowledge of risk adjustment methodologies
• Experience with actuarial modeling tools and marketplace pricing
• Strong analytical and problem-solving abilities.
• Excellence in project management and meeting deadlines.
• Outstanding communication skills with technical and non-technical audiences.
• Ability to influence and collaborate across departments.
• Strategic thinking and business acumen.

Reports to Position Title: Actuarial Director

COMPETENCIES

• Analytical Thinking
• Motivated
• Results Oriented
• Taking Initiative