Actuary, Risk and Compliance

This position is listed on behalf of a partner company, who manages all applications and next steps. Our partner is looking for an Actuary, Risk and Compliance based in United States.

The Actuary, Risk and Compliance will play a key role in identifying, evaluating, and mitigating actuarial and business risks within a complex healthcare environment.
This position supports compliant pricing and product development for Medicare Advantage and Prescription Drug Plans.
A major focus will be ensuring compliance with CMS requirements related to Total Beneficiary Cost and bid submissions.
The role combines actuarial analysis, regulatory interpretation, risk assessment, and process improvement.
You will collaborate closely with pricing actuaries and business partners to resolve compliance issues and strengthen bid-filing controls.
The position also provides opportunities to influence senior stakeholders, lead projects, and potentially manage a direct report.
This is a fully remote opportunity suited to an experienced actuarial professional with strong regulatory and communication skills.

Accountabilities

• Identify, assess, and communicate actuarial and business risks, including potential financial impacts and appropriate mitigation strategies.

• Support Medicare Advantage and Prescription Drug Plan bid filings by interpreting and implementing applicable CMS guidance, review standards, and compliance controls.

• Maintain the internal version of the CMS Out-of-Pocket Cost (OOPC) Model, coordinate required inputs from business partners, and run and interpret model results.

• Partner with pricing actuaries to investigate and resolve OOPC and Total Beneficiary Cost test failures and other compliance issues.

• Develop and maintain processes and controls designed to reduce compliance risk and improve the accuracy and consistency of bid submissions.

• Participate in CMS audits, regulatory reviews, and other assessments related to Medicare bids.

• Identify opportunities to improve bid-filing processes, tools, and controls while supporting continuous operational improvement.

• Provide actuarial peer review, technical counsel, and guidance on company, industry, regulatory, and actuarial practices.

• Monitor developments in actuarial methodologies, insurance operations, laws, and regulations and assess their potential business implications.

• Advise senior leaders on significant actuarial, regulatory, and risk-related matters and contribute to functional strategies.

• Lead projects involving actuarial and non-actuarial stakeholders, with the potential to manage and develop a direct report.

Requirements

• Bachelor’s degree required.

• 8+ years of relevant technical experience.

• At least 2 years of project leadership experience, including the ability to coordinate complex initiatives across multiple stakeholders.

• Associate of the Society of Actuaries (ASA) or Fellow of the Society of Actuaries (FSA) designation required.

• Member of the American Academy of Actuaries (MAAA) required.

• Strong understanding of actuarial risk assessment, regulatory requirements, insurance operations, and financial risk analysis.

• Demonstrated ability to analyze complex problems, evaluate potential financial consequences, and develop practical risk mitigation strategies.

• Excellent written and verbal communication skills, with the ability to clearly articulate technical concepts and recommendations to diverse audiences.

• Medicare Advantage experience is preferred, particularly experience related to pricing, product development, bid submissions, or CMS requirements.

• Experience managing large projects involving both actuarial and non-actuarial teams is preferred.

• Strong collaboration, analytical thinking, project management, and stakeholder management capabilities.

Benefits

• Base salary range of $129,300–$177,800 per year, with actual compensation varying based on location, experience, skills, education, certifications, and other job-related factors.

• Eligibility for a bonus incentive plan based on company and/or individual performance.

• Fully remote work arrangement within the United States.

• Medical, dental, and vision benefits.

• 401(k) retirement savings plan.

• Paid time off, company and personal holidays.

• Paid parental and caregiver leave.

• Short-term and long-term disability coverage.

• Life insurance and additional employee well-being programs.

• 40-hour standard workweek.

• Occasional travel to company offices may be required for training or meetings.

• Opportunity to contribute to high-impact actuarial, compliance, pricing, and risk-management initiatives in a complex healthcare environment.

How Jobgether works: We use an AI-powered matching process to ensure your application is reviewed quickly, objectively, and fairly against the role's core requirements. Our system identifies the top-fitting candidates, and this shortlist is then shared directly with the hiring company. The final decision and next steps (interviews, assessments) are managed by their internal team. We appreciate your interest and wish you the best!  Why Apply Through Jobgether?    Data Privacy Notice: By submitting your application, you acknowledge that Jobgether will process your personal data to evaluate your candidacy and share relevant information with the hiring employer. This processing is based on legitimate interest and pre-contractual measures under applicable data protection laws (including GDPR). You may exercise your rights (access, rectification, erasure, objection) at any time.     #LI-CL1