Lumeris is a physician-first healthcare transformation company dedicated to improving primary care through our AI-powered Primary Care as a Service platform. Backed by Kleiner Perkins.
About the role
Provides oversight, strategic direction, process improvements, and best practices for the department. Responsible for all actuarial and underwriting/pricing functions in support of Essence Healthcare’s Medicare Advantage plan operations. Found on 1752vc Careers, the job board for startup and VC roles.
What they're looking for
- Bachelor’s degree in Actuarial Science, Mathematics, Statistics, Economics, or related quantitative field
- Expert understanding of CMS bid mechanics, HPMS filings, CMS-HCC and RxHCC risk adjustment models, Part D direct subsidy/formulary economics, Star Ratings financial mechanics, and statutory IBNR reserving
- Proven ability to develop, support, coach, mentor, and empower a cross-functional team of credentialed actuaries, students, and healthcare economics data analysts
- Highly skilled at developing pricing strategies and plans for new products and innovative services, including specialized MA plans (e.g., Chronic or Dual-Eligible SNPs) and consumer-centric supplemental benefit packages
- Proven ability to work collaboratively across functional teams and different organizational levels to deliver results under strict, non-negotiable statutory timelines (e.g., annual June CMS bid deadline)
- Demonstrated ability to partner with sales and growth teams to evaluate Annual Enrollment Period (AEP) targets, geographic service area expansions, and competitive market positioning
More about this role
At Lumeris, we believe that our greatest achievements are made possible by the talent and commitment of our team members. That's why we are actively seeking talented and collaborative individuals who are passionate about making a difference in the healthcare industry. Join us today as we strive to create a system of care that every doctor wants for their own family and become part of a community that values its people and empowers you to make an impact.
We're excited to consider every qualified candidate authorized to work in the United States, although we are unable to sponsor visas for this role at this time.
VP, Medicare Advantage Chief Actuary
Provides oversight, strategic direction, process improvements, and best practices for the department. Responsible for all actuarial and underwriting/pricing functions in support of Essence Healthcare’s Medicare Advantage plan operations. Partnering closely with the leaders of Risk Adjustment, Pharmacy, Health Plan Product, and Stars Strategy, this role delivers forward-thinking strategies and provides business direction regarding actuarial rate setting, pricing, annual CMS Part C and Part D bid submissions, risk adjustment factor...
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