Hybrid Director, Actuarial Services

at Medical Home Network

• Job title: Director, Actuarial Services
• Job type: Full Time
• Experience level: Lead
• Salary: Not specified
• Degree requirement: Bachelor's Degree
• Tech skills: Python, SQL
• Location requirements: Hybrid, Chicago, United States

About the role

• Director of Actuarial Services at Medical Home Network applying analytical rigor to healthcare contracts. Focused on evaluating risk in Medicare, Commercial, and Medicaid frameworks.

Responsibilities

• Lead actuarial modeling and financial forecasting across CMS programs including MSSP, REACH, Medicare Advantage, and Medicaid value-based initiatives, ensuring deep alignment with current regulatory and benchmarking methodologies.
• Oversee the design and evaluation of value-based care payment models, including shared savings/loss arrangements, capitation, prospective budgets, and performance incentive programs.
• Direct enterprise-wide risk adjustment strategy for Medicare Advantage, MSSP/ACO REACH, and Medicaid, optimizing coding accuracy, risk capture processes, and prospective RAF forecasting.
• Work with contracting team to support contract negotiation including new contracts and contract renewal including shared savings, capitation, and total cost of care models.
• Partner with clinical, quality, and coding teams to ensure compliant and effective risk adjustment operations and year-round performance monitoring.
• Develop actuarial analyses supporting network design, provider performance evaluation, incentive structures, and payment model optimization across Medicare Advantage and Medicaid networks.
• Manage actuarial analysis for settlements, reconciliations, and ongoing contract performance.
• Develop and maintain an actuarial/economic framework for evaluating risk in value-based care contracts across contracts
• Identify risks and proactively develop and present mitigation recommendations for clinical and performance teams.
• Partner with data science and population health teams to enhance predictive models for patient risk stratification and care management targeting.
• Interface cross-functionally and perform analyses to fulfill the requirements of other MHN teams
• Communicate complex actuarial findings clearly to non-technical stakeholders, including clinicians, executives and external partners.

Requirements

• Bachelor’s degree in Finance, Economics, Actuarial Sciences, Statistics, Math or another quantitative field; Master’s degree or other advanced degrees in finance, economics, actuarial sciences, statistics, math or another quantitative field preferred
• 8+ years in healthcare with health plans, provider groups or consulting firms and 5+ years doing healthcare actuarial analyses; experience in value-based care
• Fellow of the Society of Actuaries (FSA) or Associate of the Society of Actuaries (ASA) designation
• Strong ability to perform data analysis using large healthcare claims and utilization datasets. Skilled in Advanced Excel modeling, with experience in SAS and SQL; familiar with R and Python.
• Experience with Word, PowerPoint, and Excel
• Knowledge of standard methods for measuring health care utilization, spending, quality, and outcomes; risk adjustment, provider profiling, and related analytical tasks
• Demonstrated ability to independently lead and execute complex, high-visibility projects with multiple stakeholders
• Proven track record of creating, maintaining, and enhancing relationships and communicating effectively with senior management
• Intense attention to detail and extraordinary commitment to assurance of data quality and integrity for important work products
• Experience with MA mechanisms and industry structure, including familiarity with STARS, the MA bid process, and the basic economics of the MA market
• Experience functioning in a highly matrixed organization and delivering complex, cross-functional projects
• Experience developing and applying consistent analytical frameworks to contracts in the value-based care space
• Experience as an independent contributor in a fast-changing operational environment of a healthcare startup or similar
• Passionate about driving the shift from fee-for-service to value-based care and securing the future of primary care and federally qualified health centers
• Experience working with projections of premiums, costs, MLR, and other aspects of MA forecasting

Benefits

• Fun, challenging, and collaborative work environment with passionate colleagues that care deeply about healthcare delivery.
• Recognized as One of the Best Places to Work in Healthcare by Modern Healthcare.
• Competitive benefits programs including Medical, Vision, Dental, HSA, FSA, and 401k.
• Fitness reimbursement, commuter benefits, and tuition assistance.
• Great work life benefits- Paid time off, sick time, and 12 paid holidays.
• Hybrid schedule: Candidates within 50 miles of Chicago are expected to work onsite 2 days per week and remotely for 3 days. Preference is for a hybrid candidate for this role but fully remote options are available for candidates located outside this area.