Position Summary
The Senior Actuary will serve as a key resource within Harbor Health's Actuarial team, leading development, pricing, reserving, risk adjustment, and financial forecasting for individual products. This role requires deep expertise in the ACA market, including the ability to navigate the legal, regulatory, and strategic landscape with innovative plans and care models. Effective collaboration with key stakeholders in Finance, Product, Health Plan Operations, and others across the organization is critical.
Key Responsibilities
Pricing & Rate Development
- Develop, maintain, and refine actuarial pricing models for Individual/ACA and other health plan lines of business, including rate filings
- Analyze claims experience, utilization patterns, demographic trends, and market developments to inform pricing strategy
- Monitor and model the impact of federal and state legal and regulatory developments
Reserving & Financial Forecasting
- Establish and maintain IBNR (Incurred But Not Reported) reserve estimates and loss ratio projections
- Prepare monthly, quarterly, and annual actuarial accruals to support financial close processes
- Provide variance analysis comparing actual results to prior projections and communicate drivers to leadership
Risk Adjustment
- Develop and lead risk adjustment accrual modeling and forecasting
- Support ACA risk score reconciliations and RADV audits
Product & Strategy Support
- Collaborate with Product and Benefit Design teams on benefit configuration, plan design analysis, and network adequacy modeling
- Provide actuarial support for market expansion decisions, product launches, and strategic initiatives
- Review public filings to understand competitor product and pricing strategies
- Develop scenario analyses and sensitivity testing to quantify financial risk and opportunity
Stakeholder Communication
- Present actuarial findings and recommendations clearly to non-actuarial audiences including Finance, Executive Leadership, and the Board
- Serve as a subject matter expert on Individual/ACA market dynamics, industry trends, and emerging actuarial methods
Qualifications
Required
- Minimum 5-10 years of actuarial experience in health insurance or managed care
- Demonstrated expertise in Individual/ACA lines of business, including ACA pricing, risk adjustment, and regulatory compliance
- Proficiency in actuarial and data analysis tools (Excel, SQL, Python, and other statistical and modeling software)
- Strong understanding of ACA market structure, regulatory framework (APTC, CSR, risk adjustment, MLR), and CMS reporting requirements
- Ability to manage multiple priorities and deliver under tight deadlines
Preferred
- Experience at an integrated payvider, health plan, or managed care organization
- Experience with Small Group and Level Funded products
Education
- Bachelor's degree in Actuarial Science, Mathematics, Statistics, Data Science, or a related quantitative field
- Fellow of the Society of Actuaries (FSA) or Associate of the Society of Actuaries (ASA) with progression toward Fellowship
- Member of the American Academy of Actuaries (MAAA) and compliant with USQS requirements for issuing Statements of Actuarial Opinion (SAOs) for ACA plans
Competencies
- Analytical rigor and attention to detail
- Clear written and verbal communication skills
- Intellectual curiosity and continuous learning mindset
- Collaborative approach across cross-functional teams
- Ability to operate independently in a fast-paced, growth-oriented environment
Harbor Health is an equal opportunity employer. We celebrate diversity and are committed to creating an inclusive environment for all employees.