Director, Actuary

WelbeHealth PACE (Program of All-Inclusive Care for the Elderly) helps seniors stay in their homes and communities by providing all-inclusive medical care and community-based services. We serve our most vulnerable seniors with better quality and compassion in a value-based model.

The Director, Actuary is accountable for all actuarial functions related to PACE revenue, claims modeling, and financial analysis. This role will focus on overseeing capitation rates, risk adjustment methodologies, claims forecasting, and Incurred But Not Reported (IBNR) reserves to guide the organization’s strategic decision-making.

Essential Job Duties:

• Direct the development, maintenance, and enhancement of the PACE revenue model, ensuring accurate accounting, forecasting, and financial planning
• Assess and refine risk-adjusted revenue projections for Medicare-Medicaid dual-eligible populations, incorporating CMS and state methodologies
• Own and enhance methodologies for claims projection, IBNR estimation, and actuarial reserve setting to ensure financial stability and regulatory compliance
• Monitor and interpret CMS, state, and Medicaid regulatory changes impacting reimbursement rates, risk scores, and capitation structures
• Oversee actuarial modeling, claims analyses, and risk assessments to improve cost-effectiveness and reimbursement accuracy
• Work closely with finance, underwriting, product development, and executive leadership to drive strategic initiatives
• Lead full scale actuarial projects and project teams, as well as participate in any required Quality Improvement activities, staff trainings, and meetings

Job Requirements:

• Bachelor's degree in actuarial science, mathematics, statistics, finance, or a related field required; ASA or FSA designation preferred
• Minimum of seven (7) years of actuarial experience, with a strong background in Duals (Medicare-Medicaid) or PACE revenue models highly preferred
• Two (2) years of supervisory experience with demonstrated ability managing teams and collaborating across departments to drive actuarial and financial initiatives preferred
• Excellent leadership, organizational, and communication skills in settings with seniors, their families and interdisciplinary team members
• Proficiency in actuarial software (e.g., SAS, SQL, Python, R), Excel, and financial modeling tools
• Deep understanding of CMS risk adjustment, Medicaid rate-setting, and Medicare Advantage/Part D payment models
• Must be willing and able to work a varied schedule that may include evening nights, weekends, and overtime

Benefits of Working at WelbeHealth: Apply your actuarial expertise in new ways as we rapidly expand. You will have the opportunity to design the way we work in the context of an encouraging and loving environment where every person feels uniquely cared for.

• 401k + employer match
• Medical insurance coverage (Medical, Dental, Vision) starting day one of employment
• Work life balance – we mean it! 17 days of personal time off (PTO), 12 holidays observed annually, sick time
• And additional benefits