Chief Actuary, Jefferson Health Plans presso Jefferson Health Plans

Job Details

We are seeking a Chief Actuary to lead the actuarial strategy and execution across our government-sponsored health programs, including Medicaid, Medicare, CHIP, and ACA. This executive will serve as a key member of the leadership team, responsible for driving pricing strategy, reserving accuracy, and trend analytics that support sustainable growth and financial performance.

The ideal candidate will bring deep technical expertise, a strong command of regulatory environments, and a collaborative leadership style to influence enterprise-wide decisions. This role also includes evaluating and optimizing the balance between internal actuarial capabilities and external consulting support, particularly for ACA and Medicare pricing functions.

Essential Functions:

• Interacts with co-workers, visitors, and other staff consistent with the values of Jefferson.

• Strategic Pricing Leadership

Own and oversee pricing strategy and rate development for Medicare, and ACA products, ensuring competitiveness and compliance with regulatory requirements.

o Evaluate and rationalize the division of pricing responsibilities between
internal actuarial teams and external consultants, particularly for ACA and
Medicare lines of business.

o Develop a roadmap to transition appropriate pricing functions in-house where
it adds strategic value, enhances agility, or improves cost-efficiency, while
maintaining strong oversight of consultant-delivered work.

o Ensure pricing methodologies are actuarially sound, data-driven, and aligned
with both regulatory expectations and enterprise financial goals.

• Reserving and Forecasting

Lead the development of actuarial reserves and financial forecasts, ensuring accuracy, transparency, and alignment with corporate financial goals.

• Trend analysis and insights

Analyze medical cost trends and utilization patterns to inform business strategy, product design, and cost containment initiatives.

• Cross Functional Collaboration

Partner with Finance, Clinical, Product, and Regulatory teams to translate actuarial insights into actionable business strategies.

• Regulatory Engagement

Serve as the actuarial point of contact for state and federal regulators, ensuring timely and accurate submissions and responses.

• Team Leadership and Development

Build, lead, and mentor a high-performing actuarial team, with a focus on recruiting top talent and expanding internal capabilities. Foster a culture of innovation, accountability, and continuous improvement to support the organization’s long-term growth and self-sufficiency.

• Data driven decision making

Champion the use of advanced analytics and predictive modeling to enhance pricing accuracy and operational efficiency.

• Strategic Pricing Leadership

Own and oversee pricing strategy and rate development for Medicare, and ACA products, ensuring competitiveness and compliance with regulatory requirements.

Job Description

Education Required:
 

• Bachelor’s degree in actuarial science, mathematics, statistics, or related field
  (Master’s preferred.)

• FSA (Fellow of the Society of Actuaries) designation required.
 

Experience Required:
 

• 10 + years of actuarial experience in health insurance, with significant

leadership in government programs (Medicaid, Medicare, CHIP, ACA).
 

Competencies (Knowledge, Skills and Abilities Required):
 

• Proficient in actuarial modeling software (e.g., SQL, SAS, R, Python, Excel,
  VBA).

• Experience in building or reviewing models related to pricing, reserving, and
  risk adjustment.

• Proven track record in pricing, reserving, and trend analysis.

• Strong understanding of regulatory frameworks and rate filing processes.

• Exceptional leadership, communication, and stakeholder management skills.

• Experience working in a matrixed or highly collaborative organizational
  structure.

• Strategic thinker with the ability to translate complex data into business
  insights.

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Work Shift

Workday Day (United States of America)

Worker Sub Type

Regular

Employee Entity

Health Partners Plans, Inc.

Primary Location Address

1101 Market, Philadelphia, Pennsylvania, United States of America

Nationally ranked, Jefferson, which is principally located in the greater Philadelphia region, Lehigh Valley and Northeastern Pennsylvania and southern New Jersey, is reimagining health care and higher education to create unparalleled value. Jefferson is more than 65,000 people strong, dedicated to providing the highest-quality, compassionate clinical care for patients; making our communities healthier and stronger; preparing tomorrow's professional leaders for 21st-century careers; and creating new knowledge through basic/programmatic, clinical and applied research. Thomas Jefferson University, home of Sidney Kimmel Medical College, Jefferson College of Nursing, and the Kanbar College of Design, Engineering and Commerce, dates back to 1824 and today comprises 10 colleges and three schools offering 200+ undergraduate and graduate programs to more than 8,300 students. Jefferson Health, nationally ranked as one of the top 15 not-for-profit health care systems in the country and the largest provider in the Philadelphia and Lehigh Valley areas, serves patients through millions of encounters each year at 32 hospitals campuses and more than 700 outpatient and urgent care locations throughout the region. Jefferson Health Plans is a not-for-profit managed health care organization providing a broad range of health coverage options in Pennsylvania and New Jersey for more than 35 years.    

Jefferson is committed to providing equal educa­tional and employment opportunities for all persons without regard to age, race, color, religion, creed, sexual orientation, gender, gender identity, marital status, pregnancy, national origin, ancestry, citizenship, military status, veteran status, handicap or disability or any other protected group or status. 

Benefits

Jefferson offers a comprehensive package of benefits for full-time and part-time colleagues, including medical (including prescription), supplemental insurance, dental, vision, life and AD&D insurance, short- and long-term disability, flexible spending accounts, retirement plans, tuition assistance, as well as voluntary benefits, which provide colleagues with access to group rates on insurance and discounts. Colleagues have access to tuition discounts at Thomas Jefferson University after one year of full time service or two years of part time service. All colleagues, including those who work less than part-time (including per diem colleagues, adjunct faculty, and Jeff Temps), have access to medical (including prescription) insurance.

For more benefits information, please click here

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