Director, Actuarial

About the Role:

We are seeking a Director of Actuarial to join our Actuarial & MedEcon team. You will have a key role in TailorCare’s expansion and in bringing our comprehensive MSK services to more patients through risk-based partnerships with health plans and other risk-bearing entities. Your responsibilities will include refining our pricing models to ensure they align with industry best practices, establishing risk mitigation strategies to help evaluate our risk-based contracts with clients, and working closely with our growth team. Additionally, you will be presenting insights to our external stakeholders on their population and managing our technical teams' relationships through the deal process.

Primary Responsibilities:

• Collaborate with leadership and executive teams, providing expertise and analysis to help shape and grow TailorCare.
• Provide expert guidance on emerging trends in healthcare technology and policies (CMS FFS, CMS MA, ACO REACH, and ACA Exchange Plans)
• Create pricing models and support pricing on all new TC deals
• Review contracts on new and existing deals from an Actuarial lens
• Evaluate medical cost and utilization trends and contract performance on all existing TC deals
• Create and maintain risk mitigation strategies (e.g., contract-based, reserving, stop-loss and/or re-insurance, etc.)
• Create and maintain innovative models that project MSK utilization, MSK cost benchmarks, and TailorCare’s cost savings
• Develop reserving methodology, calculate monthly IBNR, and report contract performance and insights into cost drivers
• Continuously monitor and improve models to ensure they meet the evolving needs of clients, regulatory requirements, and internal stakeholders
• Develop standards and processes to ensure the accuracy, reliability, and relevance of actuarial models, analyses, and reports
• Reporting on national, market, and deal-specific trends 
• Manage 3rd party actuarial consultants
• Build our actuarial career pathways and hire and mentor junior talent
• Connect and collaborate with our external partner's health economics and actuarial teams as the primary actuarial contact. We're here to build strong relationships and work together effectively!
• Champion TailorCare’s mission, values, and operating principles

Qualifications:

• Bachelor's or Master's degree in Actuarial Science, Mathematics, Statistics, or a related field is required. An Associate of the Society of Actuaries (ASA) is also required. 
• The candidate should have a minimum of 10 years of actuarial experience in healthcare focusing on pricing, claims trending, utilization management, underwriting, and/or benefits management analytics.
• Proven experience in a leadership role with the ability to manage teams and complex projects is necessary. 
• A strong background in health economics and health plan experience is also required. 
• Candidates should have expertise in actuarial modeling, statistical analysis, and predictive analytics. 
• Strong computer programming skills in SQL, R and/or Python are essential. 
• Exceptional communication skills are a must, with the ability to effectively collaborate and influence cross-functional teams. 
• Strong analytical and problem-solving abilities with a keen attention to detail.
• Ability to work collaboratively in a fast-paced, dynamic environment.
• Value-based care deal experience is a plus