Actuary, Risk and Compliance

About the role

This position is listed on behalf of a partner company, who manages all applications and next steps. Our partner is looking for an Actuary, Risk and Compliance based in United States.

The Actuary, Risk and Compliance will play a key role in identifying, evaluating, and mitigating actuarial and business risks within a complex healthcare environment. This position supports compliant pricing and product development for Medicare Advantage and Prescription Drug Plans. A major focus will be ensuring compliance with CMS requirements related to Total Beneficiary Cost and bid submissions. The role combines actuarial analysis, regulatory interpretation, risk assessment, and process improvement. You will collaborate closely with pricing actuaries and business partners to resolve compliance issues and strengthen bid-filing controls. The position also provides opportunities to influence senior stakeholders, lead projects, and potentially manage a direct report. This is a fully remote opportunity suited to an experienced actuarial professional with strong regulatory and communication skills.

Responsibilities

• Identify, assess, and communicate actuarial and business risks, including potential financial impacts and appropriate mitigation strategies.
• Support Medicare Advantage and Prescription Drug Plan bid filings by interpreting and implementing applicable CMS guidance, review standards, and compliance controls.
• Maintain the internal version of the CMS Out-of-Pocket Cost (OOPC) Model, coordinate required inputs from business partners, and run and interpret model results.
• Partner with pricing actuaries to investigate and resolve OOPC and Total Beneficiary Cost test failures and other compliance issues.
• Develop and maintain processes and controls designed to reduce compliance risk and improve the accuracy and consistency of bid submissions.
• Participate in CMS audits, regulatory reviews, and other assessments related to Medicare bids.
• Identify opportunities to improve bid-filing processes, tools, and controls while supporting continuous operational improvement.
• Provide actuarial peer review, technical counsel, and guidance on company, industry, regulatory, and actuarial practices.
• Monitor developments in actuarial methodologies, insurance operations, laws, and regulations and assess their potential business implications.
• Advise senior leaders on significant actuarial, regulatory, and risk-related matters and contribute to functional strategies.
• Lead projects involving actuarial and non-actuarial stakeholders, with the potential to manage and develop a direct report.

Requirements

• Bachelor’s degree required.
• 8+ years of relevant technical experience.
• At least 2 years of project leadership experience, including the ability to coordinate complex initiatives across multiple stakeholders.
• Associate of the Society of Actuaries (ASA) or Fellow of the Society of Actuaries (FSA) designation required.
• Member of the American Academy of Actuaries (MAAA) required.
• Strong understanding of actuarial risk assessment, regulatory requirements, insurance operations, and financial risk analysis.
• Demonstrated