Principal Actuary

Job description

**This position is listed on behalf of a partner company, who manages all applications and next steps. Our partner is looking for a Principal Actuary based in the United States.** Take a leading role in shaping how healthcare value, savings, and financial performance are measured across innovative digital health programs. As a Principal Actuary, you will build internal actuarial capabilities and develop rigorous methodologies for pricing, return on investment (ROI), and performance guarantees. Working across Finance, Clinical, Commercial, and Strategy teams, you will translate complex healthcare data into actionable insights that support sustainable business growth. You will design and evaluate value-based arrangements, assess financial exposure, and help ensure commercial commitments are grounded in reliable evidence. This position combines hands-on modeling with strategic collaboration and direct engagement with payers, benefits consultants, and senior employer stakeholders. In a remote-first environment, you will have the autonomy to establish actuarial methodologies while collaborating with cross-functional partners on key business decisions. This is an exciting opportunity for an experienced healthcare actuary to influence healthcare economics, strengthen financial accountability, and help expand access to effective, outcomes-driven care. ### Accountabilities - **Actuarial Strategy and ROI Methodology:** Build and refine actuarial models that measure program savings, financial performance, and return on investment. Partner with Clinical and Commercial teams to develop ROI methodologies for Medicare and government markets, support Star Ratings analyses, and inform future program studies and evaluations. - **Performance Guarantees and Risk Management:** Design and price performance guarantees, shared-savings arrangements, and other at-risk commercial agreements. Develop pricing and exposure models, establish measurable performance triggers and contract terms, and define actuarial safeguards for customer commitments. - **Claims-Based Analysis:** Build defensible savings studies using medical and pharmacy claims data, including matched-cohort analyses. Ensure methodologies are robust, transparent, and capable of withstanding third-party scrutiny. - **Commercial and Customer Engagement:** Represent the actuarial function in finalist presentations, RFP processes, contract renewals, and discussions with payers, employers, benefits consultants, and external actuarial teams. Clearly communicate and defend analytical assumptions, measurement approaches, and financial trade-offs. - **Portfolio Monitoring and Financial Reporting:** Model and monitor performance guarantee exposure across the customer portfolio. Identify contracts with potential financial risk and provide appropriate accrual and reserve inputs to Accounting. - **Pricing and Unit Economics:** Evaluate pricing assumptions and unit economics, accounting for medical and pharmacy cost trends, GLP-1 utilization, specialty drug management, and other factors that may influence program economics and customer outcomes. - **Model Governance and Documentation:** Establish reusable, version-controlled actuarial models and maintain clear documentation of methodologies, assumptions, and validation procedures. Support audit requirements, external disclosures, and internal quality assurance. - **Cross-Functional Partnership:** Collaborate with Finance, Strategy, Clinical, and Commercial stakeholders to build actuarial understanding, inform business decisions, and ensure that analytical findings translate into practical recommendations. - **Independent Technical Leadership:** Set actuarial methodologies, assess the soundness of financial guarantees, and provide evidence-based recommendations. Work within established governance processes for final pricing decisions, contractual commitments, material risk acceptance, accounting conclusions, and external claims. - **Analytical Innovation:** Apply advanced analytical techniques and AI-enabled tools to improve modeling efficiency and insight generation, validating outputs and protecting confidential information throughout the process. ## Requirements - **Professional Designation:** Associate or Fellow of the Society of Actuaries (ASA or FSA), in good standing. FSA and Member of the American Academy of Actuaries (MAAA) credentials are advantageous. - **Education:** Bachelor's degree in actuarial science, mathematics, statistics, economics, or another relevant quantitative discipline. - **Healthcare Actuarial Experience:** At least 10 years of healthcare actuarial experience across Medicare Advantage, government healthcare programs, payer organizations, actuarial consulting, or risk-bearing digital health or provider organizations. - **Claims-Based Modeling Expertise:** Hands-on experience working with medical and pharmacy claims data, including personally building matched-cohort analyses and claims-based savings studies that have withstood independent or third-party scrutiny. - **Value-Based Contracting:** Demonstrated experience designing, pricing, or evaluating performance guarantees, shared-savings arrangements, ROI guarantees, or other value-based commercial models, including quantifying downside financial exposure. - **Technical and Analytical Skills:** Strong SQL capabilities and advanced Microsoft Excel skills, with the ability to independently extract, analyze, model, and validate data. Experience using Python or R for modeling and automation is an advantage. - **AI and Digital Fluency:** Proven experience incorporating AI into analytical workflows, with sound judgment in validating outputs, assessing reliability, and appropriately handling confidential and sensitive information. - **Healthcare Economics Knowledge:** Strong understanding of healthcare cost drivers, medical and pharmacy trends, and the financial dynamics of healthcare programs. Experience with GLP-1 economics, specialty drug management, Medicare Advantage, Medicaid managed care, or risk adjustment methodologies is highly desirable. - **Commercial Acumen:** Ability to assess pricing structures, quantify financial risk, evaluate contractual guarantees, and balance commercial objectives with methodological rigor and financial sustainability. - **Stakeholder Communication:** Confidence presenting and defending complex actuarial methodologies to payer actuaries, analysts, benefits consultants, employer finance leaders, and internal executives. - **Strategic Thinking and Judgment:** Ability to distinguish evidence from uncertainty, challenge unsupported assumptions constructively, and translate technical findings into clear, actionable business recommendations. - **Professional Attributes:** Intellectual honesty, curiosity, strong written communication, attention to detail, and the ability to work independently while collaborating effectively across multidisciplinary teams. - **Additional Advantage:** Experience working for a digital health or point-solution provider selling to employers and payers, or an actuarial consulting background involving multiple clients and methodologies. - **Work Authorization and Location:** Applicants must reside within the 50 states of the United States. Candidates residing outside the United States are not eligible for employment due to restrictions concerning access to personal health information. ## Benefits - **Competitive Compensation:** Annual base salary ranges vary by geographic zone: - Zone 1: $228,160–$285,200 - Zone 2: $218,240–$272,800 - Zone 3: $198,400–$248,000 - **Annual Cash Bonus:** Eligibility for a competitive annual cash bonus. - **Equity Opportunities:** Equity grants that provide an opportunity to participate in the organization's long-term growth. - **Employee Stock Purchase Plan (ESPP):** Access to an employee stock purchasing program. - **Remote-First Work Environment:** Fully remote work culture for eligible employees residing in the United States. - **Flexible Time Off:** Flexible paid time off to support rest, personal commitments, and work-life balance. - **Parental Leave:** Generous parental leave to support employees and their families. - **Healthcare Coverage:** Medical, dental, and vision insurance with employer contributions described as above market. - **Retirement Savings:** Access to a 401(k) retirement savings plan. - **Lifestyle Spending Account (LSA):** Additional resources to support eligible lifestyle and well-being expenses. - **Mental Health Support:** Access to mental health support solutions and wellness resources. - **Collaborative Culture:** An environment that values trust, curiosity, bold thinking, measurable results, teamwork, and meaningful impact on healthcare. - **Professional Impact:** The opportunity to shape actuarial strategy, influence commercial decision-making, and contribute to innovative approaches to chronic disease management and healthcare delivery.