Kelsey-Seybold Managed Care Analytics exists to monitor and improve the financial performance of Kelsey-Seybold (KS) by providing actionable, data-driven insights to the organization. Within Managed Care Analytics, the Actuarial Services and Healthcare Economics teams' primary focus is to apply actuarial science rigor to pricing, forecasting, and broader analytical exercises.
The Senior Director serves as the Chief Actuary and enterprise financial leader responsible for the performance of Kelsey-Seybold's $1B+ Medicare Advantage health plan and broader Commercial risk-bearing lines of business, impacting 200K risk lives. This role has end-to-end accountability for pricing, underwriting, revenue forecasting, claims cost projection, and margin performance, as well as leadership of the Healthcare Economics (HCE) function.
This leader drives enterprise trend strategy, financial planning, and risk-based contracting, directly influencing payer negotiations, product strategy, and organizational affordability initiatives. The role partners with executive leadership optimize total cost of care, ensure actuarial and financial integrity, and deliver sustainable growth across Medicare Advantage, Exchange, and Commercial lines of business.
Primary Responsibilities:- Accountable for financial performance, forecasting, and margin outcomes across Medicare Advantage, Exchange, and Commercial lines of business
- Serving as Chief Actuary for a $1B+ Medicare Advantage plan, accountable for pricing strategy, bid development, and financial performance
- Owns pricing and underwriting strategy for Commercial risk contracts and capitated arrangements (120K lives, $350M revenue portfolio)
- Leads and develops actuarial and healthcare economics functions, ensuring depth of expertise aligned with enterprise needs
- Leads actuarial modeling and financial analysis for payer contract negotiations and value-based arrangements
- Accountable for monthly close actuarial outputs, including IBNR, claims projections, and variance analysis
- Owns enterprise analytics and reporting to quantify drivers of revenue, utilization, and cost trends
You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.
Required Qualifications:- BA/BS Degree in Economics, Mathematics, Actuarial Science or other related field.
- Associate of the Society of Actuaries (ASA) or Fellow of the Society of Actuaries (FSA)
- 10+ years of experience in data analytics, actuarial services, underwriting, or a related field inclusive of:
- 8+ years of experience supervising or managing teams and/or projects
- 5+ years as a Healthcare Actuary
- 3+ years of experience with Medicare Advantage bid development
- 3+ years of programming experience in SQL, SAS, Python or similar programming language
- Demonstrated knowledge of IBNR models
- Demonstrated knowledge of actuarial cost analysis and PMPM modeling
Preferred Qualifications:- Systems experience (i.e. enrollment/eligibility, capitation, claims payment, etc.) with an MCO
- Experience with reporting tools (including Crystal Reports and Microsoft Access)
- Knowledge of CMS HCC model and Risk Adjustment calculations
- Familiarity with EPIC and Clarity reporting data warehouse
Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $159,300 to $273,200 annually based on full-time employment. We comply with all minimum wage laws as applicable.
