Actuary - Primary Care Organization

About the Role

The Actuary, Analytics/Forecasting analyzes and forecasts financial, economic, and other data to provide accurate and timely information for strategic and operational decisions. Establishes metrics, provides data analyses, and works directly to support business intelligence. Evaluates industry, economic, financial, and market trends to forecast the organization's short, medium and long-term financial and competitive position. The Actuary, Primary Care Organization (PCO) is responsible for supporting actuarial analytics, forecasting, data integrity, and business intelligence initiatives. This role develops and executes processes and controls to ensure the accuracy, consistency, and reliability of data used in actuarial analysis and decision-making. The Actuary collaborates with business partners and stakeholders to understand business needs, identify issues, troubleshoot data anomalies, conduct root cause analyses, and develop cost-effective solutions. This position advises leaders and executives on matters of significance, including segment-specific strategies, financial trends, medical claims drivers, and the organization's short-, medium-, and long-term financial and competitive position. This role works under minimal supervision, exercises independent judgment, and makes decisions on complex actuarial matters requiring analysis of variable factors and determination of the appropriate course of action. Sponsorship is not available for this role.

Core Responsibilities

• Collaborate with stakeholders to understand business needs, clarify issues, and translate actuarial findings into actionable business insights.
• Analyze medical claims trends and identify key drivers impacting financial performance, utilization, cost, and business outcomes.
• Develop, maintain, and execute processes and controls to ensure data integrity, accuracy, and consistency across actuarial analyses and reporting.
• Troubleshoot data anomalies, perform root cause analysis, and recommend cost-effective resolutions to improve data quality and business intelligence.
• Analyze and forecast financial, economic, and business data to support strategic and operational decision-making.
• Apply actuarial modeling, technical expertise, and industry knowledge to evaluate the organization's financial and competitive position over the short, medium, and long term.
• Provide strategic guidance to executives and business leaders on matters of significance, including segment-specific actuarial and financial strategies.
• Prepare, present, and document actuarial analyses, assumptions, findings, and recommendations for leadership and key stakeholders.
• Exercise independent judgment on complex actuarial issues, evaluating variable factors and determining appropriate courses of action with minimal supervision.
• Establish metrics, monitor trends, and deliver data-driven insights that support business planning, forecasting, reporting, pricing, reserving, rate filing, and trend analysis initiatives.

Required Qualifications

• Bachelor's degree from an accredited University in the USA.
• Member of the American Academy of Actuaries (MAAA).
• Fellow of the Society of Actuaries (FSA); or Associate of the Society of Actuaries (ASA) plus one or more of the following: Experience working as an Actuary in one or more of the following insurance areas: Medicaid, Medicare Advantage, Commercial insurance.
• Experience in more than three actuarial functions, such as: Modeling, Pricing, Rate filing, Reporting and analysis, Reserving, Trending.
• Demonstrated ability to conduct actuarial analysis, interpret complex data, and provide recommendations that support business decision-making.
• Strong ability to present findings, recommendations, and actuarial analyses to stakeholders and leadership.

Preferred Qualifications

• Master's degree.
• Actuarial experience in healthcare.
• Experience using SAS, SQL, Snowflake, or other relevant data analytics, database, or reporting tools.
• Experience supporting medical claims trend analysis, forecasting, business intelligence, or financial analysis in a healthcare or managed care environment.
• Experience documenting actuarial analyses and communications in alignment with applicable actuarial standards, including ASOP 41, Actuarial Communications.

Work Style & Schedule

Remote anywhere in the USA. Occasional travel to Humana's offices for training or meetings may be required. Typical business hours are Monday-Friday, 8 hours/day, 5 days/week. Very minimal travel might be required for training, meetings, and/or conferences.

Work at Home Requirements

Must have the ability to provide a high-speed DSL or cable modem for a home office. A minimum standard speed for optimal performance of 25x10 (25 Mbps download x 10 Mbps upload) is required. Satellite and Wireless Internet service is NOT allowed for this role. A dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information is required. Associates or contractors who live and work from home in the state of California will be provided with payment for their internet expense.

Interview Format

As part of our hiring process, we will be using on-demand technology provided by HireVue, a third-party vendor. If selected to move forward from your application prescreen, you will receive correspondence inviting you to participate in an on-demand assessment with pre-determined questions. The assessment should take approximately 10-15 minutes. Your on-demand assessment will be reviewed, and you will subsequently be informed if you will be moving forward to the next round of interviews.

Pay

$129,300 - $177,800 per year. This job is eligible for a bonus incentive plan based upon company and/or individual performance.

Benefits

Humana offers competitive benefits that support whole-person well-being, including medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, paid parental and caregiver leave), short-term and long-term disability, life insurance, and many other opportunities.

About CenterWell Senior Primary Care

CenterWell Senior Primary Care provides proactive, preventive care to seniors, including wellness visits, physical exams, chronic condition management, screenings, minor injury treatment and more. Our unique care model focuses on personalized experiences, taking time to listen, learn and address the factors that impact patient well-being. Our integrated care teams, which include physicians, nurses, behavioral health specialists and more, spend up to 50 percent more time with patients, providing compassionate, personalized care that brings better health outcomes. We go beyond physical health by also addressing other factors that can impact a patient's well-being.

About CenterWell, a Humana company

CenterWell is a leading healthcare services business focused on creating integrated and differentiated experiences that put our patients at the center of everything we do. The result is high-quality healthcare that is accessible, comprehensive and, most of all, personalized. As the largest provider of senior-focused primary care, a leading provider of home healthcare and a leading integrated home delivery, specialty, hospice and retail pharmacy, CenterWell is focused on whole health and addressing the physical, emotional and social wellness of our patients. CenterWell is part of Humana Inc. (NYSE: HUM). Learn more about what we offer at CenterWell.com.