Job Description
A bit about this role:
The Pricing Actuary is a critical actuarial leader responsible for directing the strategy, modeling, and financial execution of our Commercial lines of business (e.g., Group and Self-Funded/ASO). This role requires deep expertise in Commercial rating mechanics, rating model architecture, underwriting strategy, and state regulatory rate filings.
Beyond pure technical depth, success in this role hinges on flawless operational execution: building robust pricing infrastructure, hitting non-negotiable regulatory submission deadlines, bringing process consistency to rating cycles, and working collaboratively with underwriting, sales, finance, network contracting, and state regulators.
We place the highest value on proven real-world execution, technical ability, and collaborative leadership. While professional actuarial credentials are recognized, a track record of driving timely, accurate, and profitable Commercial rating and rate review outcomes is what truly defines success in this role.
Your Responsibilities and Impact will include:
Rating Model Development & Architecture
- Rating Engine & Model Building: Build, refine, and maintain scalable actuarial rating models and pricing engines across Commercial Large Group lines of business, ensuring high technical standards and repeatable execution.
- Product & Benefit Pricing Strategy: Partner with product, clinical, and market leadership to rate competitive benefit packages, evaluating product trade-offs, cost-sharing mechanics, and benefit design changes against profitability targets.
- Assumption & Trend Development: Establish, defend, and document core actuarial pricing assumptions, including manual rates, age/gender factors, area factors, trend projections, administrative expense allocations, and margin targets.
Underwriting Partnership & Group Pricing
- Underwriting Collaboration: Contribute directly to underwriting policy and risk selection strategies for group business, providing actuarial oversight on complex quote requests, experience rating formulas, and credibility logic.
- ASO & Stop-Loss Pricing: Design and maintain pricing methodologies for Administrative Services Only (ASO) products, employer-specific fee structures, and stop-loss/reinsurance coverage options.
- Portfolio & Risk Analysis: Monitor group risk profiles, employer group renewal performance, and adverse selection dynamics, feeding insights back into rate development and underwriting guidelines.
Regulatory Submissions, Rate Reviews & State Engagement
- State Rate Filings & Defensibility: Direct the preparation, documentation, and filing of annual and quarterly Commercial rate filings across multiple state departments of insurance (DOIs) and regulatory bodies.
- State Regulatory Relations: Serve as the primary actuarial interface with state regulators throughout the rate review process, responding promptly and effectively to regulatory objections, actuarial inquiries, and public comments to secure necessary rate approvals.
- ACA Financial Mechanics: Oversee pricing mechanics related to Commercial regulatory frameworks, including ACA risk adjustment (HHS-HCCs), Medical Loss Ratio (MLR) rebate calculations, state rate cap mandates, and the No Surprises Act.
Cross-Functional Collaboration & Strategic Alignment
- Cross-Functional Partnership: Work seamlessly across Finance, Healthcare Economics, Sales/Distribution, Network Management, and Clinical Operations to ensure rating assumptions reflect actual operational capabilities, market distribution goals, and provider contracting terms.
- Executive Presentation: Prepare clear, compelling executive-level presentations summarizing rate filing strategies, portfolio rate impacts, and margin projections for executive leadership, board members, and key business partners.
Required skills and experience:
(Hands-on execution ability, proven track record, and collaborative performance take precedence over formal degrees or certifications).
- Core Actuarial & Commercial Pricing Experience: 8+ years of progressive healthcare actuarial experience, with at least 5+ years of deep, direct focus on Commercial actuarial pricing, rating model development, and regulatory rate filings.
- Model Building & Technical Mastery: Demonstrated experience building rating engines from scratch or significantly upgrading pricing tools, with proficiency in actuarial modeling and data manipulation (e.g., SQL, Python, R, SAS).
- Proven State Rate Filing Track Record: Direct experience managing the full lifecycle of Commercial rate filings through SERFF, successfully navigating state regulatory rate reviews and to secure approvals on schedule.
- Underwriting Alignment: Hands-on experience partnering with or establishing guidelines for underwriting teams, experience rating logic, and portfolio performance tracking.
- Proven Track Record of Deadline Execution: Demonstrated ability to consistently drive complex, time-sensitive filings and pricing projects to completion on schedule, managing high-stakes regulatory deadlines with poise and precision.
- Collaborative Leadership: Exceptional interpersonal skills with a proven track record of working constructively across cross-functional teams, translating complex actuarial concepts into clear strategic choices for non-actuarial partners.
Desired skills and experience:
(Actuarial designations are valued, but equivalent practical mastery and demonstrated track record are fully recognized).
- Actuarial Credentials: Associate (ASA) or Fellow (FSA) of the Society of Actuaries, and Member of the American Academy of Actuaries (MAAA). Fully equivalent experience and pricing leadership track record will be strongly considered.
- Broad Financial & Managed Care Perspective: Experience interfacing with reserving, value-based contracting, or medical economics functions.
- Startup / High-Growth Agility: Comfort operating in a fast-paced, high-growth environment where rating tools and processes are continuously developed and optimized.
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Salary Range: $175,000-$250,000 / year
The pay range listed for this position is the range the organization reasonably and in good faith expects to pay for this position at the time of the posting. Once the interview process begins, your talent partner will provide additional information on the compensation for the role, along with additional information on our total rewards package. The actual base salary offered will depend on a variety of factors, including the qualifications of the individual applicant for the position, years of relevant experience, specific and unique skills, level of education attained, certifications or other professional licenses held, and the location in which the applicant lives and/or from which they will be performing the job.
Our Total Rewards package includes:
Employer sponsored health, dental and vision plan with low or no premium
Generous paid time off
$100 monthly mobile or internet stipend
Stock options for all employees
Bonus eligibility for all roles excluding Director and above; Commission eligibility for Sales roles
Parental leave program
401K program
And more....
*Our total rewards package is for full time employees only. Intern and Contract positions are not eligible.
