Reporting to the Health Alliance Plan Chief Financial Officer, the Vice President, Chief Actuary and Underwriting Leader is responsible for actuarial strategy, pricing, underwriting, rate filings, reserving, forecasting, trend analysis, Medicare Advantage bids, model oversight, and related financial analytics. This role serves as a key advisor to Health Alliance Plan and Henry Ford Health leaders, providing actuarial insight to support enterprise forecasting, risk adjustment, value-based care, financial performance, and board/executive decision-making. The leader collaborates with Health Alliance Plan executives and enterprise stakeholders to develop and execute strategies that support pricing integrity, regulatory compliance, competitive products, sustainable membership growth, revenue performance, and operating margin goals.
PRINCIPAL DUTIES AND RESPONSIBILITIES:- Works closely with the CFO to ensure the Long-Range Financial Plan reflects the current environment as part of a complex Integrated Delivery Financial System (IDFS).
- Leads actuarial strategy, premium rate development, and regulatory rate filings for Health Alliance Plan and affiliated companies across commercial fully insured and self-funded, and Medicare Advantage products; partners with HAP CareSource on Medicaid and Michigan Coordinated Health (MICH) products.
- Develops and maintains reserving and forecasting models, trend analyses, benchmarks, and calculations to support medical cost projections, performance reporting, and financial planning.
- Provides actuarial and financial insight for annual medical expense budgets, variance reporting, provider contracting, network analysis, and value-based care strategies.
- Oversees commercial pricing and underwriting activities to support competitive rates, appropriate risk selection, revenue growth, membership growth, profitability, and regulatory compliance.
- Oversees actuarial activities for Medicare Advantage, including bid development, service area expansion analysis, risk adjustment strategy, CMS-related financial requirements, and related audits or inquiries.
- Partners cross-functionally with Finance, Product Development, Sales, Operations, Clinical, Risk Adjustment, Compliance, Legal, Provider Contracting, and senior leadership to align actuarial recommendations with benefit design, product strategy, business development, and enterprise execution.
- Establishes and maintains actuarial governance processes, including assumption documentation, model validation, pricing controls, reserve review, and appropriate review or sign-off protocols for material actuarial work.
- Ensures actuarial practices comply with applicable CMS, state regulatory, statutory reporting, internal control, and Actuarial Standards of Practice requirements.
- Advises on employer group and broker discussions as needed, providing actuarial guidance on premium rates, market conditions, and financial strategy.
- Builds, leads, and develops a high-performing actuarial and underwriting team, ensuring strong collaboration, technical excellence, and continuous improvement.
- Partners with value-based care providers to develop appropriate stop loss rates.
- Performs other related duties as assigned.
EDUCATION/EXPERIENCE REQUIRED:- Bachelor's degree in actuarial science, mathematics, finance, statistics, economics, or another quantitative discipline required; master's degree preferred.
- Minimum of seven years of progressive health actuarial experience, including pricing, product development, valuation, forecasting, financial reporting, and risk analysis.
- Experience supporting health plan products such as commercial, individual, Medicare Advantage, Medicaid, supplemental, or self-funded lines of business preferred.
- Demonstrated ability to develop actuarial models, analyze medical cost trends, and translate complex financial information into actionable business recommendations.
- Prior leadership experience, including building teams, developing employees, and managing direct or indirect reports.
- Proven ability to collaborate across Finance, Sales, Product, Operations, and senior leadership to support business strategy and financial performance.
- Strong knowledge of healthcare economics, risk adjustment, reserving, forecasting, pricing, Medicare Advantage bid strategy, value-based care economics, and actuarial model governance.
- Executive-level communication skills, including the ability to translate complex actuarial analysis into clear recommendations for senior leadership, board audiences, and cross-functional stakeholders.
CERTIFICATIONS/LICENSURES REQUIRED:- FSA and MAAA designations preferred if serving as Appointed Actuary. ASA candidates with significant health plan actuarial leadership experience may be considered.
